Continuous Transversus Abdominis Plane Blocks via Laparoscopically Placed Catheters for Bariatric Surgery

The objective of the present study is to evaluate postoperative analgesic outcome of the continuous bilateral transversus abdominis plane (TAP) block using bupivacaine infusion through an epidural catheter inserted through laparoscopic ports.

Ninety patients assigned for laparoscopic sleeve gastrectomy (LSG) were divided into two equal groups according to postoperative analgesia: Control group received IV morphine, and TAP group received bupivacaine 0.25% continuous infusion TAP block through epidural catheters introduced through laparoscopic ports, grasped, and inserted in laparoscopically prepared TAP. Catheters were removed 24 h postoperatively. Frequency and severity of postoperative pain were assessed using numeric rating scale (NRS). Cumulative pain score, number of requests, and total dose of administered rescue analgesia were recorded.

Pain scores were significantly lower throughout 24 h postoperative with a significantly lower cumulative score in the TAP group compared to the control group. Twenty-four patients in the TAP group did not require rescue analgesia, and 17 patients required it once with a significantly higher frequency of patients having a higher number of rescue analgesia requests in the control group. The mean of number of patients requested rescue analgesia; the number of requested doses and total dose of morphine received was significantly lower in the TAP group. Mean time till first ambulation and oral intake was significantly shorter, and morphine-related side effects were significantly lower in the TAP group. Total and differential satisfaction scores were significantly higher in the TAP group.

Continuous bupivacaine TAP block provided through an epidural catheter passed through laparoscopic ports improved postoperative outcome of LSG in terms of reduced postoperative pain scores, sparing morphine consumption, and early recovery items.