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

Abstract

Objective: Multimodal pain management combined with epidural analgesia and transversus abdominal plane (TAP) block after obesity surgery, reduces side effects of opioids by decreasing its usage and ensuring effective postoperative pain control in obese patients with expanded fat mass. But performing both epidural and TAP block in obese patients is technically difficult, and sometimes it is impossible. Performing the TAP block laparoscopically may be a solution to this technical difficulty. In this study, technical success and efficacy of laparoscopic transversus abdominis plane block in the laparoscopic sleeve gastrectomy was assessed. Methods: This study was designed as prospectively randomized, double-blinded and placebo-controlled. Laporoscopic sleeve gastrectomy (LSG) patients underwent TAP infiltration of 30 cc bupivacaine (Group T) or saline (Group S) was administered to bilateral petit and subcostal area in patients underwent laparoscopic sleeve gastrectomy. One hundred sixty five patients were included in the study. All patients were administered with postoperative patient-controled analgesia device and dosed with tenoxicam 20 mg IV at postoperative 1st and 8th hours. The analgesic requirement, mean pain score, vital parameters of all patients and if any of the patients presented with nausea and vomiting were assessed by an objective observer at postoperative 1st, 6th and 24th hours. Results: There was no statistically significant difference between age, body maas index, mean duration of operation and gender, laparoscopic TAP block groups (p>0.05). When the visual analogue scale score was evaluated, the mean scores of the 1st, 6th, and 24th hours in the control group (Group S) were found as statistically significantly higher than Group T (p=0.009, p=0.002). Conclusion: It is noteworthy that reduction of opioid-related side effects by the usage of multimodal analgesic technique, particularly in morbidly obese patients undergoing surgery. In this study, it was projected that laparoscopic TAP block can be applied with high rate of success and reduces postoperative opioid consumption in LSG operations.