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Background <p>Patients undergoing laparoscopic gastric bypass (LGBP) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LGBP in a high-volume bariatric center, applying an enhanced recovery after metabolic and bariatric surgery protocol.</p> Materials and methods <p>84 patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU), and at 6, 12, and 24&#xa0;h after surgery. Secondary outcomes included postoperative nausea and/or vomiting, analgesic requirement, time to walking, time to flatus, length of hospital stay, and surgical complications.</p> Results <p>Differences were observed in intra-group comparisons (LG-TAP vs. placebo) for the primary outcome—NRS in postoperative analgesia—with a median (IQR) NRS of 4 (2–5) vs. 2 (2–5) in PACU, 4.5 (2–6) vs. 2.5 (1–6) at 6&#xa0;h and 3 (0–5) vs. 2 (0–4) at 12&#xa0;h, although no statistically differences were demonstrated (PACU: <i>p</i>-value = 0.26; 6&#xa0;h: <i>p</i>-value = 0.3; 12&#xa0;h: <i>p</i>-value = 0.24). No statistically and clinically differences were observed for NRS at 24&#xa0;h postoperatively with a median (IQR) of 1 (0–3) vs. 1 (0–4) at 24&#xa0;h; <i>p</i> = 0.89. No differences were observed as regards secondary outcomes.</p> Conclusion <p>While a potential analgesic effect of saline solution through fascial hydrodissection cannot be excluded, our results more convincingly support that LG-TAP block provides no significant analgesic effect when LA-PSI is adequately implemented.</p>

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Laparoscopic-guided transversus abdominis plane block combined with port-site infiltration for postoperative analgesia after gastric bypass: a randomized, double-blind, controlled trial

  • 期刊论文

  • 发表日期：

    2025年6月30日

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  • Rita Cataldo,
  • Vincenzo Bruni,
  • Sabrina Migliorelli,
  • Ida Francesca Gallo,
  • Giuseppe Spagnolo,
  • Giulia Gibin,
  • Miriam Borgetti,
  • Alessandro Strumia,
  • Alessandro Ruggiero,
  • Giuseppe Pascarella

摘要

Background

Patients undergoing laparoscopic gastric bypass (LGBP) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LGBP in a high-volume bariatric center, applying an enhanced recovery after metabolic and bariatric surgery protocol.

Materials and methods

84 patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU), and at 6, 12, and 24 h after surgery. Secondary outcomes included postoperative nausea and/or vomiting, analgesic requirement, time to walking, time to flatus, length of hospital stay, and surgical complications.

Results

Differences were observed in intra-group comparisons (LG-TAP vs. placebo) for the primary outcome—NRS in postoperative analgesia—with a median (IQR) NRS of 4 (2–5) vs. 2 (2–5) in PACU, 4.5 (2–6) vs. 2.5 (1–6) at 6 h and 3 (0–5) vs. 2 (0–4) at 12 h, although no statistically differences were demonstrated (PACU: p-value = 0.26; 6 h: p-value = 0.3; 12 h: p-value = 0.24). No statistically and clinically differences were observed for NRS at 24 h postoperatively with a median (IQR) of 1 (0–3) vs. 1 (0–4) at 24 h; p = 0.89. No differences were observed as regards secondary outcomes.

Conclusion

While a potential analgesic effect of saline solution through fascial hydrodissection cannot be excluded, our results more convincingly support that LG-TAP block provides no significant analgesic effect when LA-PSI is adequately implemented.