Analgesic effect of postoperative laparoscopic-guided transversus abdominis plane (TAP) block, associated with preoperat
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and Other Interventional Techniques
Analgesic effect of postoperative laparoscopic‑guided transversus abdominis plane (TAP) block, associated with preoperative port‑site infiltration, within an enhanced recovery after surgery protocol in one‑anastomosis gastric bypass: a randomized clinical trial Jaime Ruiz‑Tovar1,2 · Gilberto Gonzalez1 · Andrei Sarmiento1 · Miguel A. Carbajo1 · Javier Ortiz‑de‑Solorzano1 · Maria Jose Castro1 · Jose Maria Jimenez1 · Lorea Zubiaga1 Received: 24 July 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The use of ultrasonography to assist needle placement during transverse abdominal plane (TAP) technique has provided direct visualization of surround anatomical musculature and facial planes. However, the increased girth in patients undergoing bariatric surgery is challenging to visualize via ultrasonography which may lead to poor postoperative analgesia. Objective The aim of the study is to investigate whether the addition of postoperative laparoscopic-guided TAP block as part of a multimodal analgesic regimen within the ERAS protocol compared to no block provides better postoperative analgesia in patients undergoing one-anastomosis gastric bypass surgery. Patients and methods A prospective clinical trial was performed. Patients were randomized into two groups: patients undergoing postoperative laparoscopic-guided TAP (TAP-lap) and patients not receiving TAP-lap (Control). Multimodal analgesia included preoperative port-site infiltration with Bupivacaine 0.25% in both groups and systemic Acetaminophen. Pain quantification as measured by visual analogic scale (VAS) was assessed at 6 and 24 h after surgery, and 24-h postoperative opioid consumption. Results One hundred and forty patients were included, 70 in each group. The mean operation time was 78.5 ± 14.4 min in TAP-lap and 75.9 ± 15.6 min in Control (NS). The mean postoperative pain, as measured by VAS, 6 h after surgery was 23.1 ± 11.3 mm in TAP-lap and 41.8 ± 16.2 mm in Control (p = 0.001). 24 h after surgery was 16.6 ± 11.4 mm in TAP-lap and 35.4 ± 12.7 mm in Control (p = 0.001). Morphine rescues were necessary in 14.2% in Control and 2.8% in TAP-lap (p = 0.035). Conclusion Laparoscopic-guided TAP block as part of a multimodal analgesia regimen can reduce postoperative pain and opioid consumption, without increasing operative time. Keywords Transversus abdominis plane block · TAP · One-anastomosis gastric bypass · OAGB · Enhanced recovery after surgery · ERAS · Multimodal analgesia · Postoperative pain
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-019-07341-5) contains supplementary material, which is available to authorized users. * Jaime Ruiz‑Tovar [email protected] 1
Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
Rey Juan Carlos University Hospital, Madrid, Spain
2
Bariatric surgery, usually performed laparoscopically, is an effect
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