Efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery: a double blind, randomized, controlled study.
BACKGROUND
The efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block as a part of multimodal analgesia was evaluated in morbidly obese patients undergoing laparoscopic bariatric surgery.


METHODS
We studied 100 patients with body mass index > 35 kg/m2. They were randomly allocated to study (USG-TAP) and control groups. Pain scores at rest and on movement at various time points up to 24 postoperative hours were compared. Other parameters evaluated were patients requiring Tramazac hydrochloride (TMZ) as rescue analgesic, sedation score, time to ambulate, any adverse events, and patient satisfaction.


RESULTS
The median visual analogue scale pain score of the study (USG-TAP) group was consistently lower at 1, 3, 6, 12, and 24 h at rest and on movement, in the postoperative period. Number of patients requiring TMZ required in the first, third, and sixth hour was significantly lower in the USG-TAP group. The prolonged sedative effect of the TMZ affected the time to ambulate. Patients in the control group remained more sedated. Four patients in the control group required BIPAP support postoperatively; no adverse event was observed. Time to ambulate was 6.3 ± 1.8 h in USG-TAP and 8 ± 1.8 h in control groups; P < 0.001. Patient satisfaction scores were significantly higher in the USG-TAP group; P < 0.001.


CONCLUSIONS
Our study demonstrates that the USG-TAP as part of multimodal analgesic technique in morbidly obese patients undergoing laparoscopic gastric bypass reduces opioid requirement, improves pain score, decreases sedation, promotes early ambulation, and has greater patient satisfaction.
Institute of Minimal access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India. apsin@hotmail.com
Aparna
A
Sinha
Lakshmi
L
Jayaraman
Dinesh
D
Punhani
D000009:Abdominal Muscles / Q000187:drug effects / Q000294:innervation*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage; D050110:Bariatric Surgery / Q000379:methods; D016292:Procedural Sedation; D004311:Double-Blind Method; D005260:Female; D015391:Gastroplasty / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009767:Obesity, Morbid / Q000000981:diagnostic imaging / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
D000701:Analgesics, Opioid; D000779:Anesthetics, Local