• Eric Albrecht, Kyle R Kirkham, Ryan V W Endersby, Vincent W S Chan, Timothy Jackson, Allan Okrainec, Todd Penner, Rongyu Jin, and Richard Brull.
• Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
• Obes Surg. 2013 Aug 1;23(8):1309-14.

BackgroundDespite the laparoscopic approach, patients can suffer moderate to severe pain following bariatric surgery. This randomized controlled double-blinded trial investigated the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) blocks for laparoscopic gastric-bypass surgery.MethodsSeventy patients undergoing laparoscopic gastric-bypass surgery were randomized to receive either bilateral ultrasound-guided subcostal TAP block injections after induction of general anesthesia or none. All patients received trocar insertion site local anesthetic infiltration and systemic analgesia. The primary outcome was cumulative opioid consumption (IV morphine equivalent) during the first 24 h postoperatively. Interval opioid consumption, pain severity scores, rates of nausea or vomiting, and rates of pruritus were measured during phase I recovery, and at 24 and 48 h postoperatively.ResultsThere was no difference in cumulative opioid consumption during the first 24 h postoperatively between the TAP (32.2 mg [95% CI, 27.6-36.7]) and control (35.6 mg [95% CI, 28.6-42.5]; P = 0.41) groups. Postoperative opioid consumptions during phase I recovery and the 24-48-h interval were similar between groups, as were pain scores at rest and with movement during all measured intervals. The rates of nausea or vomiting and pruritus were equivalent.ConclusionsBilateral TAP blocks do not provide additional analgesic benefit when added to trocar insertion site local anesthetic infiltration and systemic analgesia for laparoscopic gastric-bypass surgery.

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