Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery-a Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Effective postoperative analgesia is paramount in patients undergoing bariatric surgery, given their increased predisposition to narcotic-induced respiratory depression. Transversus abdominis plane (TAP) block has shown promise in the enhanced recovery pathway for several abdominal procedures. We performed a systematic review and meta-analysis to compare the effectiveness of TAP block in laparoscopic bariatric surgery. PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until June 2020. All randomized trials that compared TAP blocks versus none in laparoscopic bariatric procedures were included. The primary outcome was narcotic consumption at 24h postoperatively, whilst secondary outcomes included postoperative pain scores at 24h, time to ambulation, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates. Seven randomized controlled trials were included, capturing 617 patients. There was high statistical heterogeneity across studies. On random effects analysis, there were no significant differences in narcotic consumption (MD -12.63mg, 95% CI = -31.67 to 6.41, p = 0.19), pain scores (MD -0.71, 95% CI = -1.93 to 0.50, p = 0.25) or complications (RD = -0.00, 95% CI = -0.03 to 0.03, p = 0.87) between TAP and no TAP groups. However, TAP was associated with significantly less time to ambulation (MD -2.22h, 95% CI = -3.89 to -0.56, p = 0.009) and PONV (OR = 0.13, 95% CI = 0.05 to 0.35, p < 0.0001). TAP in laparoscopic bariatric surgery is associated with significantly less PONV and time to ambulation, but similar complication rates, narcotic usage and postoperative pain at 24h compared to no TAP.