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Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery—a Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Abstract

Purpose

Effective postoperative analgesia is paramount in patients undergoing bariatric surgery, given their increased predisposition to narcotic-induced respiratory depression. Transversus abdominis plane (TAP) block has shown promise in the enhanced recovery pathway for several abdominal procedures. We performed a systematic review and meta-analysis to compare the effectiveness of TAP block in laparoscopic bariatric surgery.

Materials and Methods

PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until June 2020. All randomized trials that compared TAP blocks versus none in laparoscopic bariatric procedures were included. The primary outcome was narcotic consumption at 24 h postoperatively, whilst secondary outcomes included postoperative pain scores at 24 h, time to ambulation, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates.

Results

Seven randomized controlled trials were included, capturing 617 patients. There was high statistical heterogeneity across studies. On random effects analysis, there were no significant differences in narcotic consumption (MD −12.63 mg, 95% CI = −31.67 to 6.41, p = 0.19), pain scores (MD −0.71, 95% CI = −1.93 to 0.50, p = 0.25) or complications (RD = −0.00, 95% CI = −0.03 to 0.03, p = 0.87) between TAP and no TAP groups. However, TAP was associated with significantly less time to ambulation (MD −2.22 h, 95% CI = −3.89 to −0.56, p = 0.009) and PONV (OR = 0.13, 95% CI = 0.05 to 0.35, p < 0.0001).

Conclusions

TAP in laparoscopic bariatric surgery is associated with significantly less PONV and time to ambulation, but similar complication rates, narcotic usage and postoperative pain at 24 h compared to no TAP.

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Author information

Author notes

  1. MAA and SMS contributed equally to this work and are joint first authors

Authors and Affiliations

  1. Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland

    Muhammad Awais Aamir & Shaheel Mohammad Sahebally

  2. Department of Surgery, St Vincent’s University Hospital, Dublin, Ireland

    Shaheel Mohammad Sahebally & Helen Heneghan

  3. Section of Surgery, School of Medicine, University College Dublin, Dublin, Ireland

    Helen Heneghan

Authors
  1. Muhammad Awais Aamir
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  2. Shaheel Mohammad Sahebally
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  3. Helen Heneghan
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Contributions

Conceived and designed experiments: MAA, SMS, HH.

Performed the experiments: MAA, SMS.

Analysed the data: MAA, SMS, HH.

Wrote the manuscript: MAA, SMS, HH.

Corresponding author

Correspondence to Shaheel Mohammad Sahebally.

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Electronic supplementary material

Supplementary Fig. 1

Sensitivity analysis of narcotic consumption at 24 h in ultrasound-guided TAP block only (PNG 1627 kb)

High resolution image (TIFF 129 kb)

Supplementary Fig. 2

Sensitivity analysis of time to ambulation in laparoscopic sleeve gastrectomy only (PNG 233 kb)

High resolution image (TIFF 144 kb)

Supplementary Fig. 3

Sensitivity analysis of complications in laparoscopic sleeve gastrectomy only (PNG 1592 kb)

High resolution image (TIFF 126 kb)

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Aamir, M.A., Sahebally, S.M. & Heneghan, H. Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery—a Systematic Review and Meta-Analysis of Randomized Controlled Trials. OBES SURG 31, 133–142 (2021). https://doi.org/10.1007/s11695-020-04898-2

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