How Effective is Transversus Abdominis Plane Block in Reducing Pain and Opioid Needs Following Bariatric Surgery?

Several studies have found that ultrasound-guided transversus abdominis plane (TAP) block is useful for pain management with bariatric surgery. In this study, we have examined perioperative pain management and opioid needs of totally robotic (TR) Roux-en-Y gastric bypass and sleeve gastrectomy patients who had or did not have a TAP block as part of their enhanced recovery after bariatric surgery protocol and multimodal analgesia (MMA) regimen. The study was a retrospective analysis of 149 primary totally robotic bariatric surgeries performed with (n = 75) or without (n = 74) TAP block between April 2022 and December 2022. Measures included: (1) patient characteristics, (2) surgical outcomes, and (3) early and late postoperative (PO) pain intensity and cumulative opioid needs. Pain scores and opioid usage were assessed in the post-anesthesia care unit (PACU) and the first 24 h of the hospital stay. Patient characteristics, operative time, time in PACU, and length of stay did not significantly differ between patients who had a TAP block and those who did not. Pain scores (early or late) did not differ significantly with or without TAP block, nor did 24-h opioid consumption (6.24 and 6.23 morphine milliequivalents) or the number of patients requiring opioids for pain management (37% vs. 42%, respectively). Surgery expenses were significantly higher with TAP block due to the added costs of the procedure ($713.31). TAP block had no additive benefit to our MMA regimen in reducing PO pain and opioid usage.