The Efficacy of Transversus Abdominis Plane Blocks in Roux-en-Y Gastric Bypass - a Systematic Review and Meta-Analysis of Randomised Control Trials.

Abstract

Background: Transversus abdominis plane (TAP) block is commonly used as an element of multimodal analgesia following abdominal surgery; however, its efficacy in Roux-en-Y gastric bypass (RYGB) remains uncertain.

Aim: To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the effectiveness of TAP block following RYGB.

Methods: A comprehensive search was performed as per PRISMA guidelines. RCTs comparing TAP block with control in adult patients undergoing RYGB were included. Primary outcomes were postoperative pain scores (visual analogues scores (VAS)/numeric rating scale (NRS)) in recovery and at 6, 12, and 24-hours. Data analytics were performed using RevMan v.5.3.

Results: Five RCTs comprising 481 patients were included. TAP block did not significantly reduce pain scores in recovery, at 6-hours, or at 12-hours postoperatively. A significant reduction in pain was observed at 24-hours (mean difference (MD) -0.57, 95% CI -0.96- -0.17, p = 0.005, I² = 92%). Patients receiving TAP block were significantly less likely to require breakthrough opioid analgesia (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02-0.32, p = 0.0003, I² = 51%). TAP block was also associated with earlier ambulation (MD -1.65, 95% CI -2.32- -0.98, p < 0.00001, I² = 0%). No significant differences were observed in PONV or LOS.

Conclusion: While TAP block provided limited benefit in early postoperative pain control in patients undergoing RYGB, it was associated with reduced 'breakthrough' opioid requirements, earlier mobilisation, and a significant analgesic effect at 24 h. These findings support the use of TAP blocks as an opioid-sparing adjunct within enhanced recovery after bariatric surgery pathways.