• Hytham K S Hamid, Amjed Y Ahmed, Alan A Saber, Sameh H Emile, Mohamed Ibrahim, and Jaime Ruiz-Tovar.
• Department of Surgery, Soba University Hospital, Khartoum, Sudan. Electronic address: kujali2@gmail.com.
• Surg Obes Relat Dis. 2020 Sep 1; 16 (9): 1349-1357.

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.Copyright © 2020 American Society for Bariatric Surgery. All rights reserved.

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