Continuous Transversus Abdominis Plane Block After Laparoscopic Sleeve Gastrectomy in 50 Consecutive Cases.

Purpose: Enhanced recovery after bariatric surgery is important for decreasing morbidity, enhancing functional recovery and shortening the length of stay. Ultrasound-guided transversus abdominis plane (TAP) block has been known to decrease pain scores and opioid requirement after bariatric surgery. We aimed to investigate the efficacy of continuous TAP block in 50 consecutive cases of laparoscopic sleeve gastrectomy (LSG). Materials and Methods: From February 2022 to April 2022, 50 cases of LSG were performed with ultrasound-guided TAP blocks. The data was compared to that of 157 cases of primary LSG that had been performed from January to December of 2021. Ultrasound guided TAP block was performed from the epigastric port site 3 to 5 mm in size that was placed for liver retraction during LSG. The lateral border of the rectus abdominis muscle was identified. A 17-gauge T-peel inducer and sheath (On-Q® Pain Buster®) were inserted in a medial to lateral direction towards the TAP. Fifteen to 20 mL of normal saline was injected for plane dissection and the catheter was inserted through the sheath after removal of the inducer. The same was performed for the other side in the same order. The elastomeric pump was injected with 100 mg of 0.5% bupivacaine and connected to the 2 catheters. Results: There was no significant difference in mean age, initial body weight, preoperative body mass index (BMI), incidence of diabetes, hypertension, obstructive sleep apnea, and length of postoperative hospital stay between the TAP group and the non-TAP group. The TAP group had a higher incidence of dyslipidemia. There were statistically significant differences in the clinical outcomes regarding the numerical rating scale (NRS) score at postoperative 12, 24 and 48 hours, opioid injection within 24 hours (non-TAP group 36.82% vs. TAP group 20%, P value=0.037) and ramosetron injection within 24 hours (non-TAP group 9.45% vs. TAP group 0%, P value=0.017). There was no significant difference between the 2 groups in postoperative NRS scores at 1 and 6 hours, incidence of nausea or vomiting, injection of acetaminophen, non-steroidal anti-inflammatory drugs, or metoclopramide within 24 or 48 hours, injection of opioid or ramosetron within 48 hours. There were 2 cases of complications related to continuous TAP block where there was difficulty in removing the catheters and needed to be removed under local anesthesia. Conclusion: Although continuous TAP block did not reduce cumulative opioid consumption, the need for additional opioid and antiemetic injection can be reduced within the postoperative 24 hours.