Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials
M. Földi, Alexandra Soós, Péter Hegyi, Szabolcs Kiss, Zsolt Szakács, Margit Solymár, Erika Pétervári, Márta Balaskó, Krzysztof Kusza, Zsolt Molnár
Abstract
PURPOSE: Pain after bariatric surgery can prolong recovery. This patient group is highly susceptible to opioid-related side effects. Enhanced Recovery After Surgery guidelines strongly recommend the administration of multimodal medications to reduce narcotic consumption. However, the role of ultrasound-guided transversus abdominis plane (USG-TAP) block in multimodal analgesia of weight loss surgeries remains controversial. MATERIALS AND METHODS: A systematic search was performed in four databases for studies published up to September 2019. We considered randomized controlled trials that assessed the efficacy of perioperative USG-TAP block as a part of multimodal analgesia in patients with laparoscopic bariatric surgery. RESULTS: Eight studies (525 patients) were included in the meta-analysis. Pooled analysis showed lower pain scores with USG-TAP block at every evaluated time point and lower opioid requirement in the USG-TAP block group (weighted mean difference (WMD) = - 7.59 mg; 95% CI - 9.86, - 5.39; p < 0.001). Time to ambulate was shorter with USG-TAP block (WMD = - 2.22 h; 95% CI - 3.89, - 0.56; p = 0.009). This intervention also seemed to be safe: only three non-severe complications with USG-TAP block were reported in the included studies. CONCLUSION: Our results may support the incorporation of USG-TAP block into multimodal analgesia regimens of ERAS protocols for bariatric surgery.