Ziyad Nasrawi, MD, Toni Beninato, MD, FACS, Krystyna Kabata, PA, Stella Iskandarian, BS, Michael E Zenilman, MD, FACS, Piotr Gorecki, MD, FACS. NYP Brooklyn Methodist Hospital
Objective: Laparoscopic guided transversus abdominis plane (LGTAP) block following laparoscopic sleeve gastrectomy (LSG) has been proposed as a method of improving perioperative pain control in bariatric patients. In this study, we aim to further optimize pain control, improve patient satisfaction, facilitate early ambulation and expedite return to normal activity in patients who underwent LGTAP block at the completion of the LSG.
Patients and Methods: This is a retrospective analysis of a prospectively collected database of 140 patients who underwent laparoscopic sleeve gastrectomy (LSG) without TAP block (pre-TAP group) in comparison to 131 patients who underwent LSG followed by laparoscopic guided TAP block (TAP group). All operations were performed by a single surgeon (PG) at a single institution utilizing the same clinical pathways. All operations were completed laparoscopically. Baseline characteristics for both groups were comparable (age, sex and initial weight and BMI). Both groups of patients received standardized general anesthesia, followed by a routine intravenous patient-controlled analgesia (PCA) and intravenous acetaminophen postoperatively for 24 hours. Outcomes measures included time to postoperative ambulation (evaluated at 2 and 6 hours, followed by every 4 hours overnight), average pain scores, morphine PCA volume utilized, length of hospital stay, return to activity and return to work.
Results: Both groups of patients (pre-TAP vs. TAP) were comparable (mean age 42 years, p = 0.99, women 81.4% vs. 87.8% (p=0.148), mean BMI 46 vs. 45 (p=0.394).
Most patients in both groups were able to ambulate within 2 hours after arrival to the floor (87.9% vs. 76.3%, p=0.013); in addition, 97.14% vs. 93.89% ambulated within 6 hours (p=.195), and 77.86% vs. 70.99% (p=.063) reported ambulation every 4 hours overnight.
On a first postoperative day, a mean reported pain score was 4.5 vs. 5.06 (p=0.063) and a mean PCA morphine used for 24 hours was 26.3 cc vs. 26 cc, p=0.35. Mean hospital stay was 1.44 vs. 1.25 days (p=0.056). Pre-TAP group reported a mean of 2.81 days to return to activities vs. 2.08 days for the TAP group (p<0.001). When controlled for age, BMI, OR time, PCA volume used and average pain score, TAP block was an independent predictor of earlier return to activities.
Conclusion: LGTAP block following sleeve gastrectomy may be an additional valuable modality of pain control in the perioperative period. Our study has shown that TAP block is associated with an earlier return to activities in patients undergoing LSG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94707
Program Number: S110
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium
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