Laparoscopic Transversus Abdominal Plane Block is Effective in Multimodal Analgesia for Laparoscopic Sleeve Gastrectomy

Tülübaş, Evrim Küçür; Seyit, Hakan; Bostancı, İpek; Demir, Güray; Köşük, Hilal; Şeker, Yasemin Tekdöş; Peker, Kevser; Alış, Halil

doi:10.4274/btdmjb.galenos.2018.20180528093003

Cited by 8 publications

(2 citation statements)

References 15 publications

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“…In contrast to our results, Tülübaş et al ( 24 ) designed a prospective randomized study in patients who underwent laparoscopic sleeve gastrectomy. The results showed that there was not any significant difference in both groups regarding postoperative opioid consumption.…”

Section: Discussioncontrasting

confidence: 86%

Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study

et al. 2023

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Background: Morbid obesity may cause a restrictive condition. General Anesthesia (GA) and supine posture both decrease lung capacity and functional residual capacity (FRC), altering the ventilation/perfusion ratio and raising the pulmonary shunt. Objectives: To evaluate the impact of recruitment maneuver (RM) and transversus abdominis plane (TAP) block performed during laparoscopic bariatric surgery on spirometry, oxygenation, opioid requirements, and pain score assessed after surgery. Methods: This pilot prospective randomized controlled study included 80 patients scheduled for elective laparoscopic bariatric surgeries (e.g., laparoscopic sleeve gastrectomy and laparoscopic gastric bypass) under GA. Patients were divided into four equal groups. All patients received a standardized postoperative analgesia regimen. Group I (control group), group II received TAP block after intubation and before surgical incision, group III received RM after intubation and after pneumoperitoneal insufflation, and group IV received RM after intubation and after pneumoperitoneal exsufflation and TAP block after intubation and before surgical incision. Results: Forced vital capacity (FVC) and Forced expiratory volume (FEV1) were significantly higher after group IV operation than in other groups. Intraoperative PaO2 and PaO2/FiO2 were significantly higher in groups III and IV compared to other groups. The numerical rating scale (NRS) at 1, 2, 4, 6, and 12h was significantly decreased in groups II and IV compared to other groups. Morphine consumption was significantly lower in groups II and IV compared to other groups. Conclusions: TAP block combined with RM had better postoperative pulmonary function tests. Intraoperative oxygenation was higher in RM.

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Section: Discussioncontrasting

confidence: 86%

Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study

et al. 2023

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“…Out of 92 potentially relevant citations, 15 randomized studies (5,(23)(24)(25)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)) and 6 non-randomized studies (47)(48)(49)(50)(51)(52) were selected (Fig. 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

2021

Pain Phys

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BACKGROUND: Patients undergoing bariatric surgery present unique analgesic challenges, including poorly controlled pain, increased prevalence of obstructive sleep apnea, and opioid-induced respiratory depression. The transversus abdominis plane (TAP) has been demonstrated to be a safe and effective component of multimodal analgesia for a variety of abdominal surgeries. OBJECTIVE: To determine the benefits of the TAP block on postoperative analgesia and recovery in patients undergoing bariatric surgery. STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies. METHODS: We conducted a comprehensive search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to April 2020 for studies using TAP block in bariatric surgeries and reporting postoperative pain, opioid consumption, and recovery-related outcomes. Primary outcomes included postoperative pain scores, opioid consumption, and recovery-related outcomes (e.g., length of stay, time to ambulation). Outcomes were pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS: Twenty-one studies (15 RCTs [n = 1410] and 6 nonrandomized studies [n = 1959]) were included. Among RCTs, the TAP block group required fewer opioid rescues (RR 0.28; 95% CI 0.18 to 0.42, P < 0.001) (moderate quality); reduced total opioid use over 24 hours (MD –8.33; 95% CI –14.78 to –1.89, P = 0.01); decreased time to ambulation (MD –1.12 hours; 95% CI –1.50 to –0.73, P < 0.001) (high quality); and had significantly lower pain scores at 6 hours (MD –1.52; 95% CI –1.90 to –1.13, P < 0.01) and 12 hours (MD –0.95; 95% CI –1.34 to –0.56, P < 0.001) on a 0-10 pain scale (moderate quality). No difference was observed for nausea and vomiting, or hospital length of stay. Meta-analyzed outcomes from observational studies supported these results, suggesting decreased postoperative pain and opioid consumption. LIMITATIONS: Studies varied with respect to type of surgery and components of comparator multimodal analgesia, likely contributing to heterogeneity. Subgroup analyses by type of comparator group were conducted to address these differences. We were unable to extract data from all trials included due to variability in outcomes reporting, such as non-opioid drugs for postoperative pain management or invalid dosages. Pain-related outcomes may be affected by operative differences leading to variation in visceral pain. Observational studies have their inherent limitations, such as confounding due to lack of participant randomization and intervention blinding, potentially affecting subjective outcomes, such as pain scores, as well as provider-dependent outcomes, such as hospital length of stay. Lastly, there was significant variation of TAP block technique across all studies. CONCLUSION: TAP block is an effective, safe modality that can be performed under anesthesia. It decreases pain, opioid use, and time to ambulation after bariatric surgeries and should be considered in multimodal analgesia for enhanced recovery in this high-risk surgical population. KEY WORDS: Analgesia, bariatric surgery, enhanced recovery after surgery, multimodal analgesia, opioid-sparing analgesia, pain, postoperative, regional block, transversus abdominis plane block

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Regional anaesthesia for postoperative pain management following laparoscopic, visceral, non-oncological surgery a systematic review and meta-analysis

Lohmöller,

Carstensen,

Pogatzki-Zahn

et al. 2024

Surg Endosc

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Laparoscopic Transversus Abdominal Plane Block is Effective in Multimodal Analgesia for Laparoscopic Sleeve Gastrectomy

Cited by 8 publications

References 15 publications

Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study

Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study

Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

Regional anaesthesia for postoperative pain management following laparoscopic, visceral, non-oncological surgery a systematic review and meta-analysis

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