The TAP block in obese patients: pros and cons

Abstract

a B s t r a c t the growing number of laparoscopic surgical procedures performed in obese patients has increased the need to explore suitable analgesic techniques for a prone population to postoperative complications. the morbidly obese population may particularly benefit from the opioid-sparing or the opioid-free anesthesia/analgesia, which maximize the use of locoregional techniques. transversus abdominal plane (taP) block has been widely used as part of multimodal analgesia for abdominal and gynecological surgeries, but evidence in obese patients is still poor. The efficacy of TAP block in morbidly obese patients undergoing laparoscopic bariatric surgery is still under discussion, because ultrasound visualization of the abdominal wall muscles can be challenging due to the excessive subcutaneous fat. inadequate needle positioning, failed regional analgesia, and possible related risks must be counterbalanced by adequate evidence of effectiveness. the present article will discuss the pros and cons of taP block in the treatment of obese patients.(Cite this article as: ruiz-tovar J, albrecht e, Macfarlane a, coluzzi F. the taP block in obese patients: pros and cons.

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

“…Furthermore, BMI was significantly associated with race and ethnicity, with the group of Black or African American patients having the highest median BMI among all racial or ethnic groups. The association between BMI and postoperative pain has been reported by other studies as well ( 22 , 23 ). Postulated mechanisms for the decreased effectiveness of regional anesthetic techniques in obese patients include an increased rate of failure to accurately identify anatomical landmarks ( 23 , 24 ), and altered pharmacokinetics of local anesthetics in adipose tissue ( 22 ).…”

Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy

“…Moreover, patients with this condition often have comorbidities that require anticoagulation therapy. Although ultrasound-guided transversus abdominis plane (TAP) block may be beneficial, it is still a matter of debate [1].…”

Regional Anesthesia in Adult Patients with Obesity

“…The authors recommended this approach, which has a low risk of peritoneal puncture under direct visualization and can provide long-term pain relief. Regarding transversus abdominis plane (TAP) blocks in obese patients, it was claimed that the identification of the abdominal wall muscles could be difficult because of superimposed adipose tissue, needle positioning and US-visualization of LA spread could be challenging and RA failure may occur (8,62) . However; these theoretical problems are not clinically reflected in all studies.…”