Transversus abdominis plane block using a short-acting local anesthetic reduces pain and opioid consumption after laparoscopic bariatric surgery: a meta-analysis |
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| Affiliation: | 1. Department of Surgery, Soba University Hospital, Khartoum, Sudan;2. Director Bariatric & Metabolic Surgery Program, Newark Beth Israel Medical Center, Newark, New Jersey;3. Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt;4. Department of Anesthesiology, Zagazig University, Zagazig, Egypt;5. Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Madrid, Spain;1. Department of Surgery, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey;2. Department of Biostatistics, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey;3. Department of Clinical Excellence, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey;4. Department of Anesthesia, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey;5. Department of Medicine, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey;1. Christiana Care Surgical Residency Program, Newark, Delaware;2. Christiana Care Value Institute, Newark, Delaware;3. Christiana Care Wilmington Chief Surgical Services, Wilmington, Delaware;1. Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea;2. Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea;3. Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea;4. Department of Anesthesiology and Pain Medicine, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea;1. Division of Colorectal Surgery, University Hospitals-Case Medical Center, Cleveland, OH;2. Department of Surgery, University Hospitals-Case Medical Center, Cleveland, OH |
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| Abstract: | BackgroundTransversus abdominis plane (TAP) block is a form of regional anesthesia that has been increasingly employed in minimally invasive surgery. The data regarding its use in laparoscopic bariatric surgery, however, are still limited and at times controversial.ObjectivesThe aim of this meta-analysis was to assess the efficacy of TAP block after laparoscopic bariatric surgery.SettingSoba University Hospital, Sudan.MaterialsA systematic search was conducted through the Embase, Cochrane Collaboration, and PubMed databases for randomized controlled trials evaluating the effects of TAP block in patients undergoing laparoscopic bariatric surgery. Meta-analysis was performed using a random effects model. Primary endpoints were late (24 hr) pain scores at rest and on movement. Secondary endpoints included early (0–3 hr) pain scores at rest and on movement, opioid consumption, time to ambulation, length of hospital stay, and adverse events.ResultsTen randomized controlled trials met our inclusion criteria, with 404 patients in the TAP block groups and 413 patients in the control groups. TAP block was associated with significantly improved late pain scores (at rest, standardized mean difference [SMD] −.95, P < .001; on movement, SMD −1.04, P = .01) and early pain scores (at rest, SMD −1.81, P < .001; on movement, SMD −1.80, P < .001), reduced postoperative opioid consumption at 24 hours (SMD −2.23 mg intravenous morphine, P < .001), a shorter time to ambulation (SMD −1.07 hours, P < .001), and reduced incidence of postoperative nausea and vomiting (OR .20, P = .01). No significant difference was noted regarding length of hospital stay (P = .70). Postoperative TAP block administration resulted in greater effects on opioid consumption at 24 hours compared with preoperative block administration. Finally, none of the studies reported any adverse effect of local anesthetic.ConclusionGiven the significant effect on early and late postoperative pain, opioid consumption, and postoperative recovery and the low risk profile, TAP block using a short-acting anesthetic should be encouraged in routine practice in patients undergoing laparoscopic bariatric surgery. |
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| Keywords: | Laparoscopic bariatric surgery TAP block Postoperative pain Opioid Meta-analysis |
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