Abstract
Background
Despite the laparoscopic approach, patients can suffer moderate to severe pain following bariatric surgery. This randomized controlled double-blinded trial investigated the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) blocks for laparoscopic gastric-bypass surgery.
Methods
Seventy patients undergoing laparoscopic gastric-bypass surgery were randomized to receive either bilateral ultrasound-guided subcostal TAP block injections after induction of general anesthesia or none. All patients received trocar insertion site local anesthetic infiltration and systemic analgesia. The primary outcome was cumulative opioid consumption (IV morphine equivalent) during the first 24 h postoperatively. Interval opioid consumption, pain severity scores, rates of nausea or vomiting, and rates of pruritus were measured during phase I recovery, and at 24 and 48 h postoperatively.
Results
There was no difference in cumulative opioid consumption during the first 24 h postoperatively between the TAP (32.2 mg [95% CI, 27.6–36.7]) and control (35.6 mg [95% CI, 28.6–42.5]; P = 0.41) groups. Postoperative opioid consumptions during phase I recovery and the 24–48-h interval were similar between groups, as were pain scores at rest and with movement during all measured intervals. The rates of nausea or vomiting and pruritus were equivalent.
Conclusions
Bilateral TAP blocks do not provide additional analgesic benefit when added to trocar insertion site local anesthetic infiltration and systemic analgesia for laparoscopic gastric-bypass surgery.
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Acknowledgments
Dr. Richard Brull is supported by the Merit Award Program, Department of Anesthesia, University of Toronto. Equipment support for research was provided from BK Medical, Philips Healthcare and SonoSite.
Conflict of Interest
Dr. Eric Albrecht has received grants from the “Swiss Academy for Anaesthesia Research” (SACAR), Lausanne, Switzerland (no grant numbers attributed). None of the other authors report any conflict of interest.
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Albrecht, E., Kirkham, K.R., Endersby, R.V.W. et al. Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Laparoscopic Gastric-Bypass Surgery:a Prospective Randomized Controlled Double-Blinded Trial. OBES SURG 23, 1309–1314 (2013). https://doi.org/10.1007/s11695-013-0958-3
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DOI: https://doi.org/10.1007/s11695-013-0958-3