Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surger
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Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials Mária Földi 1,2,3 & Alexandra Soós 1,2,3 & Péter Hegyi 1,2,4 & Szabolcs Kiss 1,2,3 & Zsolt Szakács 1,2 & Margit Solymár 1,2 & Erika Pétervári 1,2 & Márta Balaskó 1,2 & Krzysztof Kusza 5 & Zsolt Molnár 1,2,5 Received: 23 June 2020 / Revised: 7 September 2020 / Accepted: 10 September 2020 # The Author(s) 2020
Abstract Purpose Pain after bariatric surgery can prolong recovery. This patient group is highly susceptible to opioid-related side effects. Enhanced Recovery After Surgery guidelines strongly recommend the administration of multimodal medications to reduce narcotic consumption. However, the role of ultrasound-guided transversus abdominis plane (USG-TAP) block in multimodal analgesia of weight loss surgeries remains controversial. Materials and Methods A systematic search was performed in four databases for studies published up to September 2019. We considered randomized controlled trials that assessed the efficacy of perioperative USG-TAP block as a part of multimodal analgesia in patients with laparoscopic bariatric surgery. Results Eight studies (525 patients) were included in the meta-analysis. Pooled analysis showed lower pain scores with USGTAP block at every evaluated time point and lower opioid requirement in the USG-TAP block group (weighted mean difference (WMD) = − 7.59 mg; 95% CI − 9.86, − 5.39; p < 0.001). Time to ambulate was shorter with USG-TAP block (WMD = − 2.22 h; 95% CI − 3.89, − 0.56; p = 0.009). This intervention also seemed to be safe: only three non-severe complications with USG-TAP block were reported in the included studies. Conclusion Our results may support the incorporation of USG-TAP block into multimodal analgesia regimens of ERAS protocols for bariatric surgery. Keywords Pain . Bariatric surgery . TAP block . Meta-analysis
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04973-8) contains supplementary material, which is available to authorized users. * Zsolt Molnár [email protected]; [email protected] 1
Institute for Translational Medicine, Medical School, University of Pécs, 12 Ifjúság St., Pécs 7624, Hungary
2
Szentágothai Research Centre, University of Pécs, Pécs, Hungary
3
Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
4
Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
5
Department of Anesthesiology and Intensive Therapy, Poznan University for Medical Sciences, Poznan, Poland
Pain in the postoperative period can cause serious suffering to patients, prolong recovery, and increase healthcare costs [1]. However, postoperative pain management can be a major challenge as previous studies demonstrated that it is frequently suboptimal [2–4]. Laparoscopic bariatric surgeries are con
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