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Minerva Anestesiologica 2019 September;85(9):1024-31

DOI: 10.23736/S0375-9393.19.13545-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

The TAP block in obese patients: pros and cons

Jaime RUIZ-TOVAR ^{1, 2, 3}, Eric ALBRECHT ⁴, Alan MACFARLANE ^{5, 6}, Flaminia COLUZZI ⁷ ✉

¹ Department of Surgery, Alfonso X University, Madrid, Spain; ² Unit of Bariatric Surgery, Department of Surgery, Rey Juan Carlos University Hospital, Madrid, Spain; ³ Center of Excellence for the Treatment of Obesity, Valladolid, Spain; ⁴ Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland; ⁵ Department of Anesthesiology, Glasgow Royal Infirmary, Glasgow, UK; ⁶ University of Glasgow, Glasgow, UK; ⁷ Unit of Anesthesia, Intensive Care and Pain Medicine, Department Medical and Surgical Sciences and Biotechnologies, Bariatric Center of Excellence and Metabolic Surgery (IFSO-EC), Sapienza University, Polo Pontino, Latina, Italy

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.

KEY WORDS: Local anesthesia; Nerve block; Obesity; Postoperative pain; Opioid analgesics