The effects of laparoscopic guided transversus abdominis plane (TAP) block in sleeve gastrectomy procedure: a randomized single blinded placebo controlled trial

Year 2024, Volume: 7 Issue: 3, 264 - 269, 27.05.2024

Ömer Faruk Bük , Sönmez Ocak , Mustafa Safa Uyanık , İlter Soytürk , Ahmet Burak Çiftci , Mehmet Alperen Avcı , Can Akgün

https://doi.org/10.32322/jhsm.1459785

Abstract

Aims: Laparoscopy-guided transversus abdominis plane (TAP) block is a novel postoperative analgesic modality. We aimed to explore the effect of TAP block in laparoscopic sleeve gastrectomy (LSG) procedures.
Methods: Forty patients were randomized into two groups: TAP block with bupivacaine and placebo. Visual analog scale scores at postoperative hours 1, 6, 12, and 24, total analgesic consumption and opioid doses, and postoperative nausea and vomiting (PONV) scores were evaluated between the groups.
Results: Postoperative first-hour VAS scores differed significantly between the groups (p<0.05). PONV scores were also lower in the TAP block group (p<0.05). The first rescue opiod requirement was later in the TAP block group than in the placebo group. Pain scores at postoperative hours 6, 12, and 24 and total analgesia doses were not significantly different between the groups.
Conclusion: Laparoscopy-guided TAP block reduced early postopeative pain and may also attenuate PONV in LSG.

Keywords

Sleeve gastrectomy, Transversus abdominis plane block, postoperative pain management

References

• Vitiello A, Abu-Abeid A, Dayan D, Berardi G, Musella M. Long-term results of laparoscopic sleeve gastrectomy: a review of studies reporting 10+ years outcomes. Obes Surg. 2023;33(11):3565-3570. doi: 10.1007/s11695-023-06824-8
• Sakran N, Soifer K, Hod K, et al. Long-term reported outcomes following primary laparoscopic sleeve gastrectomy. Obes Surg. 2023;33(1):117-128. doi: 10.1007/s11695-022-06365-6
• Vital R, Navez J, Gunes S, et al. Long-term outcomes 10 years after laparoscopic sleeve gastrectomy: a single center retrospective analysis. Obes Surg. 2023;33(8):2356-2360. doi: 10.1007/s11695-023-06709
• Clapp B, Wynn M, Martyn C, Foster C, O’Dell M, Tyroch A. Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. Surg Obes Relat Dis. 2018 Jun;14(6):741-747. doi: 10.1016/j.soard.2018.02.027.
• Khorgami Z, Shoar S, Andalib A, Aminian A, Brethauer SA, Schauer PR. Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017 ay;13(5):774-778. doi: 10.1016/j.soard.2017.01.031. Epub 2017 Jan 25.
• English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2020 Apr;16(4):457-463
• Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255-265. doi: 10.1001/jama.2017.20897
• Alvarez A, Singh PM, Sinha AC. Postoperative analgesia in morbid obesity. Obes Surg. 2014;24(4):652-659. doi: 10.1007/s11695-014-1185-2
• Macfater H, Xia W, Srinivasa S, et al. Evidence-based management of postoperative pain in adults undergoing laparoscopic sleeve gastrectomy. World J Surg. 2019;43(6):1571-1580. doi: 10.1007/s00268-019-04934-y
• Wendling A, Wudyka A. Narcotic addiction following gastric bypass surgery-a case study. Obes Surg. 2011;21(5):680-683. doi: 10.1007/s11695-010-0177-0
• Maciejewski ML, Smith VA, Berkowitz TSZ, et al. Long-term opioid use after bariatric surgery. Surg Obes Relat Dis. 2020;16(8):1100-1110. doi: 10.1016/j.soard.2020.04.037
• Bartlett MA, Mauck KF, Daniels PR. Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc Health Risk Manag. 2015;11:461-477. doi: 10.2147/VHRM.S73799
• Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-1026. doi: 10.1046/j.1365-2044.2001.02279-40.x
• El Hachem L, Small E, Chung P, et al. Randomized controlled double-blind trial of transversus abdominis plane block versus trocar site infiltration in gynecologic laparoscopy. Am J Obstet Gynecol. 2015;212(2):182.e1-182.e9. doi: 10.1016/j.ajog.2014.07.049
• Hamid HK, Emile SH, Saber AA, Ruiz-Tovar J, Minas V, Cataldo TE. Laparoscopic-guided transversus abdominis plane block for postoperative pain management in minimally invasive surgery: systematic review and meta-analysis. J Am Coll Surg. 2020; 231(3):376-386. doi: 10.1016/j.jamcollsurg
• Peng K, Ji FH, Liu HY, Wu SR. Ultrasound-guided transversus abdominis plane block for analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Med Princ Pract. 2016;25(3):237-246. doi: 10.1159/000444688
• Park SY, Park JS, Choi GS, Kim HJ, Moon S, Yeo J. Comparison of analgesic efficacy of laparoscope-assisted and ultrasound-guided transversus abdominis plane block after laparoscopic colorectal operation: a randomized, single-blind, non-inferiority trial. J Am Coll Surg. 2017;225(3):403-410. doi: 10.1016/j.jamcollsurg.2017.05.017
• Zhao X, Tong Y, Ren H, et al. Transversus abdominis plane block for postoperative analgesia after laparoscopic surgery: a systematic review and meta-analysis. Int J Clin Exp Med. 2014; 7(9):2966-2975.
• Johns N, O’Neill S, Ventham NT, Barron F, Brady RR, Daniel T. Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis. 2012;14(10):e635-e642. doi: 10.1111/j.1463-1318.2012.03104.
• Saber AA, Lee YC, Chandrasekaran A, et al. Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG): a double-blind randomized controlled trial. Am J Surg. 2019;217(1):126-132. doi: 10.1016/j.amjsurg.2018.07.010
• Martin SP, Etzel J, Aghazarian G, Wert Y, Answine JF, DiMarco L. Perioperative multimodal anesthetic care incorporating transversus abdominis plane block is associated with reduced narcotic use in laparoscopic sleeve gastrectomy. Am Surg. 2022; 88(2):242-247. doi: 10.1177/0003134820988823
• Ruiz-Tovar J, Garcia A, Ferrigni C, et al. Laparoscopic-guided transversus abdominis plane (tap) block as part of multimodal analgesia in laparoscopic roux-en-y gastric bypass within an enhanced recovery after surgery (ERAS) program: a prospective randomized clinical trial. Obes Surg. 2018;28(11):3374-3379. doi: 10.1007/s11695-018-3376-8
• Wong KA, Cabrera AG, Argiroff AL, et al. Transversus abdominis plane block with liposomal bupivacaine and its effect on opiate use after weight loss surgery: a randomized controlled trial. Surg Obes Relat Dis. 2020;16(7):886-893. doi: 10.1016/j.soard.2020.03.031
• Zhang J, Liu T, Zhou H, Fei Y, Yu X. The safety and efficacy of ultrasound-guided bilateral dual transversus abdominis plane (BD-TAP) block in ERAS program of laparoscopic hepatectomy: a prospective, randomized, controlled, blinded, clinical study. Drug Des Devel Ther. 2020;14:2889-2898. doi: 10.2147/DDDT.S255385
• Abdalla E, Kamel EZ, Farrag WS. Intravenous dexamethasone combined with intrathecal atropine to prevent morphine-related nausea and vomiting after cesarean delivery: a randomized double-blinded study. Egyptian J Anaesthesia, 2019;35(1):65-70.
• Jadon A, Amir M, Sinha N, Chakraborty S, Ahmad A, Mukherjee S. Quadratus lumborum or transversus abdominis plane block for postoperative analgesia after cesarean: a double-blinded randomized trial. Braz J Anesthesiol. 2021:S0104-0014(21)00263-3. doi: 10.1016/j.bjane.2021.06.014
• Almarshad FM, Almegren M, Alshuaibi T, et al. Thromboprophylaxis after bariatric surgery. Blood Res. 2020; 55(1):44-48. doi: 10.5045/br. 2020.55.1.44
• Minkowitz HS, Gruschkus SK, Shah M, Raju A. Adverse drug events among patients receiving postsurgical opioids in a large health system: risk factors and outcomes. Am J Health Syst Pharm. 2014;71(18):1556-1565. doi: 10.2146/ajhp130031
• Arthur J, Hui D. Safe Opioid use: management of opioid-related adverse effects and aberrant behaviors. Hematol Oncol Clin North Am. 2018;32(3):387-403. doi: 10.1016/j.hoc.2018.01.003
• Raebel MA, Newcomer SR, Bayliss EA, et al. Chronic opioid use emerging after bariatric surgery. Pharmacoepidemiol Drug Saf. 2014;23(12):1247-1257. doi: 10.1002/pds.3625
• King WC, Chen JY, Belle SH, et al. Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surg Obes Relat Dis. 2017;13(8):1337-1346. doi: 10.1016/j.soard.2017.04.003
• Mohanty S, Lee J, Ross R, Stricklen A, Carlin A, Ghaferi A. New persistent opioid use after bariatric surgery. J Am Coll Surg. 2017; 225(4):S123.
• Mittal T, Dey A, Siddhartha R, Nali A, Sharma B, Malik V. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: a randomized single blinded case control study. Surg Endosc. 2018;32(12):4985-4989. doi: 10.1007/s00464-018-6261-6
• Abdelhamid BM, Khaled D, Mansour MA, Hassan MM. Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy: a randomized controlled trial. Minerva Anestesiol. 2020; 86(8):816-826. doi: 10.23736/s0375-9393.20.14064-1
• Bhakta A, Glotzer O, Ata A, Tafen M, Stain SC, Singh PT. Analgesic efficacy of laparoscopic-guided transverse abdominis plane block using liposomal bupivacaine in bariatric surgery. Am J Surg. 2018;215(4):643-646. doi: 10.1016/j.amjsurg.2017.09.006
• Nasrawi Z, Beninato T, Kabata K, Iskandarian S, Zenilman ME, Gorecki P. Laparoscopic-guided transversus abdominis plane block following laparoscopic sleeve gastrectomy is associated with an earlier return to activity: a study of 271 patients. Surg Endosc. 2020; 34(5):2197-2203.
• Nasrawi Z, Beninato T, Kabata K, Iskandarian S, Zenilman ME, Gorecki P. Laparoscopic-guided transversus abdominis plane block following laparoscopic sleeve gastrectomy is associated with an earlier return to activity: a study of 271 patients. Surg Endosc. 2020; 34(5):2197-2203. doi: 10.1007/s00464- 019-07008-1
• Okut G, Turgut E, Kaplan K, et al. Does laparoscopic-guided transversus abdominis plane block have an effect on postoperative pain and recovery after sleeve gastrectomy? Eur Rev Med Pharmacol Sci. 2022;26(15):5406-5412. doi: 10.26355/eurrev_202208_29408
• Ravichandran NT, Sistla SC, Kundra P, Ali SM, Dhanapal B, Galidevara I. Laparoscopic-assisted tranversus abdominis plane (TAP) block versus ultrasonography-guided transversus abdominis plane block in postlaparoscopic cholecystectomy pain relief: randomized controlled trial. Surg Laparosc Endosc Percutan Tech. 2017;27(4):228-232. doi: 10.1097/SLE.0000000000000405
• Zaghiyan KN, Mendelson BJ, Eng MR, Ovsepyan G, Mirocha JM, Fleshner P. Randomized clinical trial comparing laparoscopic versus ultrasound-guided transversus abdominis plane block in minimally invasive colorectal surgery. Dis Colon Rectum. 2019; 62(2):203-210. doi: 10.1097/DCR.0000000000001292
• Algyar MF, Abdelsamee KS. Laparoscopic assisted versus ultrasound guided transversus abdominis plane block in laparoscopic bariatric surgery: a randomized controlled trial. BMC Anesthesiol. 2024;24(1):133. doi: 10.1186/s12871-024-02498-6
• Saranteas T. Limitations in ultrasound imaging techniques in anesthesia: obesity and muscle atrophy? Anesth Analg. 2009; 109(3):993-994. doi: 10.1213/ane.0b013e3181ae09a4
• Feigenbaum H. Physics and instrumentation. In: Feingenbaum H, Armstrong WF, Rayan T, eds. Feigenbaum’s echocardiography. Lippincott William and Wilkins: 2005:12-15.
• Groene P, Eisenlohr J, Zeuzem C, Dudok S, Karcz K, Hofmann-Kiefer K. Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery. Wideochir Inne Tech Maloinwazyjne. 2019;14(1):90-95. doi: 10.5114/wiitm.2018.77629
• Mendes MN, Monteiro RES, Martins FA. Prophylaxis of postoperative nausea and vomiting in morbidly obese patients undergoing laparoscopic gastroplasties: a comparative study among three methods. Rev Bras Anestesiol. 2009;59(5):570-576.
• Moussa AA, Oregan PJ. Prevention of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery: granisetron alone vs granisetron combined with dexamethasone/ droperidol. Middle East J Anaesthesiol. 2007;19(2):357-367.