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

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 USG-TAP 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.

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

“…Epidural analgesia for postoperative pain is effective but is not required in laparoscopic surgery. Ultrasound-guided transversus abdominis plane block can decrease pain scores and opioid requirement, and improve ambulation after bariatric surgery [ 134 ]. Infiltration of bupivacaine 0.5% before incision results in a reduction in opioid consumption and postoperative pain [ 135 ].…”

Learning curve of ultrasound-guided surgeon-administered transversus abdominis plane (UGSA-TAP) block on a porcine model

“…The majority (83 %) of the simulation-based TAP block learning group passed the assessment compared to only (33 %) of the video-based TAP block learning group, showcasing that simulation-based learning can significantly impact learner capabilities ( Table 2 ). Similarly, several studies have assessed simulation-based learning and found it compelling due to significantly improving the trainee's comfort level and confidence/success, which further supports the efficacy of simulation-based surgical education [ [34] , [35] , [36] ].…”

“…UGSA-TAP block is a viable concept. The increasing popularity of the UGSA-TAP block can be attributed to the confidence of the trainee surgeons in performing the fascial plane block, which is well known to be safe either performed by an anesthesia or non-anesthesia provider [ 36 ]. Our study recommends that education and training on TAP block are necessary for surgeons interested in performing the UGSA-TAP block.…”

Comparative Study Between the Mini-Open (≤2.5 Cm) Approach and Conventional Open Lateral Approach in the Surgical Treatment of Radial Head Fractures

“…Postoperative pain may affect patients’ motivation to engage in rehabilitation exercises. 35 , 36 Meanwhile, pain intensity is aggravated by rehabilitation, which may limit the patient’s participation. 37 A previous study have shown that lack of rehabilitation is an independent risk factor for stiff elbow.…”