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Meta-Analysis
. 2021 Feb;31(2):531-543.
doi: 10.1007/s11695-020-04973-8. Epub 2020 Oct 21.

Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials

Mária Földi  1   2   3 , Alexandra Soós  1   2   3 , Péter Hegyi  1   2   4 , Szabolcs Kiss  1   2   3 , Zsolt Szakács  1   2 , Margit Solymár  1   2 , Erika Pétervári  1   2 , Márta Balaskó  1   2 , Krzysztof Kusza  5 , Zsolt Molnár  6   7   8
Affiliations
Meta-Analysis

Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials

Mária Földi et al. Obes Surg. 2021 Feb.

Abstract

Purpose: Pain after bariatric surgery can prolong recovery. This patient group is highly susceptible to opioid-related side effects. Enhanced Recovery After Surgery guidelines strongly recommend the administration of multimodal medications to reduce narcotic consumption. However, the role of ultrasound-guided transversus abdominis plane (USG-TAP) block in multimodal analgesia of weight loss surgeries remains controversial.

Materials and methods: A systematic search was performed in four databases for studies published up to September 2019. We considered randomized controlled trials that assessed the efficacy of perioperative USG-TAP block as a part of multimodal analgesia in patients with laparoscopic bariatric surgery.

Results: Eight studies (525 patients) were included in the meta-analysis. Pooled analysis showed lower pain scores with USG-TAP block at every evaluated time point and lower opioid requirement in the USG-TAP block group (weighted mean difference (WMD) = - 7.59 mg; 95% CI - 9.86, - 5.39; p < 0.001). Time to ambulate was shorter with USG-TAP block (WMD = - 2.22 h; 95% CI - 3.89, - 0.56; p = 0.009). This intervention also seemed to be safe: only three non-severe complications with USG-TAP block were reported in the included studies.

Conclusion: Our results may support the incorporation of USG-TAP block into multimodal analgesia regimens of ERAS protocols for bariatric surgery.

Keywords: Bariatric surgery; Meta-analysis; Pain; TAP block.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of study selection and inclusion process
Fig. 2
Fig. 2
Forest plots that show efficacy endpoints for the comparison of “USG-TAP” and “control”. a Forest plot for pain score within the first 24 postoperative hours (VAS or NRS, 0–10). b Forest plot showing 24-h postoperative morphine requirement (mg). c Forest plot showing time to ambulate (h). USG-TAP, ultrasound-guided transversus abdominis plane block; VAS, Visual Analog Scale; NRS, Numbering Rating Scale
Fig. 3
Fig. 3
Risk of bias summary: review authors’ judgments about each risk of bias item for each included study
See this image and copyright information in PMC

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