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Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block Combined with Port-Site Infiltration (PSI) for Laparoscopic Sleeve Gastrectomy in an ERABS Pathway: A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial

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Abstract

Purpose

Patients undergoing laparoscopic sleeve gastrectomy (LSG) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LSG in a high-volume bariatric center, applying an enhanced recovery after bariatric surgery (ERABS) pathway.

Material and Methods

One hundred ten patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU) and at 6, 12, and 24 h after surgery. Secondary outcomes included postoperative nausea and/or vomiting (PONV), analgesic requirement, time to walking, time to flatus, length of hospital stay (LOS), and surgical complications.

Results

No significant differences were observed between LG-TAP and placebo groups in postoperative analgesia, with a median (IQR) NRS of 2 (4.75–0) vs. 2 (5.25–0) in PACU, 5.5 (7–3) vs. 6 (7–4) at 6 h, 2 (6–0) vs. 3 (5.25–1.75) at 12 h, and 2 (3.75–0) vs. 1 (2–0) at 24 h; all p > 0.05. A significant difference was found in PONV in PACU (LG-TAP, 46%; placebo, 25%, p-value, 0.019) and at 6 h postoperatively (LG-TAP, 69%, placebo, 41%, p-value, 0.003). No differences were observed as regards other secondary outcomes.

Conclusion

Our results suggest that LG-TAP block is not related to more effective postoperative analgesia compared to placebo when LA-PSI is performed.

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Data Availability

Data are available on request from the corresponding author.

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Authors and Affiliations

  1. Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy

    Rita Cataldo, Sabrina Migliorelli, Miriam Borgetti, Alessandro Strumia, Alessandro Ruggiero & Giuseppe Pascarella

  2. Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy

    Vincenzo Bruni, Ida Francesca Gallo, Giuseppe Spagnolo & Giulia Gibin

  3. Research Unit of Anesthesia and Intensive Care, Department of Medicine and Surgery, Università Campus Bio-Medico, 00128, Rome, Italy

    Rita Cataldo

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Correspondence to Sabrina Migliorelli.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the local ethical committee.

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Key points

• Postoperative pain reduction is crucial in patients undergoing bariatric surgery.

• LG-TAP block has become increasingly popular in multimodal opioid-sparing analgesia.

• LG-TAP block seems to be not related to a more effective postoperative analgesia.

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Cataldo, R., Bruni, V., Migliorelli, S. et al. Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block Combined with Port-Site Infiltration (PSI) for Laparoscopic Sleeve Gastrectomy in an ERABS Pathway: A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial. OBES SURG (2024). https://doi.org/10.1007/s11695-024-07292-4

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