Laparoscopic-Assisted Transversus Abdominis Plane Block Is Superior to Port Site Infiltration in Reducing Post-Operative Opioid Use in Laparoscopic Surgery

Abstract

Background: The ultrasound-guided transversus abdominis plane (TAP) block can be time-consuming, costly, and technically challenging in the bariatric patient population. Laparoscopic-assisted TAP (L-TAP) block was developed and has been shown to be non-inferior to ultrasound-guided blocks. Postoperative pain can be significant, and pain control in the morbidly obese patients can be challenging. This study's aim was to compare L-TAP block to traditional port site infiltration in terms of postoperative opioid requirement for morbidly obese patients after laparoscopic Roux-en-Y gastric bypass (RYGB) surgery.Methods: A retrospective chart review was performed from February 2019 through February 2020. Two study groups: L-TAP block and port site infiltration. Outcomes examined the amount of opioid used at different time segments relative to the operation. All intravenous (IV) and oral opioids used were converted into IV morphine milligram equivalents (MME) for standardization.Results: 150 patients were included. The patient characteristics were not statistically significant between the two groups. Post-operative opioid use trended lower in the L-TAP block group in all time segments. A significant difference was detected in IV opioid use during post-operative day 0 with the mean MME for the L-TAP block group being 1.1±3.8 and port site infiltration group being 2.8±4.5 (P = .02). Conclusions:The L-TAP block more effectively reduces postoperative opioid use in comparison to port site infiltration in laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. Based on these findings, as well as the efficiency and costeffectiveness of L-TAP blocks, its routine use in laparoscopy should be considered.

Laparoscopic assisted versus ultrasound guided transversus abdominis plane block in laparoscopic bariatric surgery: a randomized controlled trial

“…However, the US may not be a potential option in all medical centers; hence, LAP guidance may serve as an alternative where surgeons can apply the block without depending on the US using a LAP camera [46]. Moreover, Seiler et al [47] reported a significant reduction in IV opioid use postoperatively in the LTAP group compared with the control group in all postoperative measurements for morbidly patients with obesity after LAP Roux-en-Y gastric bypass surgery.…”