Does ultrasound-guided transversus abdominis plane blockade decrease perioperative opioids in morbid obese patients undergoing laparoscopic surgery?

Abstract

OBJECTIVE\nIntroduction: The recent recommendations have luck of information about regional anesthesia as one of the ERAS key component within the structure of multimodal analgesia in obese patients .The Ultrasound- guided Transversus abdominis plane blockade (USG- TAP-blockade) is a new regional anesthetic technique to reduce peri-operative pain for many abdominal surgeries. The aim of this study is to assess the efficiency of analgetic action of USG- TAP-blockade in morbid obese (MO) patients undergoing laparoscopic surgery (LS).\n\n\nPATIENTS AND METHODS\nMaterials and methods: 90 MO patients were assigned to one of two equal groups; The first group (n1=45) included patients who underwent LS surgery in the lower abdomen and in the pelvis, second group (n2=45) included patients, who underwent LS surgery in the upper and middle part of the abdominal cavity. All patients had bilateral USG- TAPblockade with systemic analgesia .The primary efficacy end point- reduction of the intraoperative dose of opioids, the need for rescue analgesia in the first 6 postoperative hours.\n\n\nRESULTS\nResults: The fentanyl intravenous dose in n1=55 was considerably decreased : 1.34 ±0.15 μg / kg /h vs 2.2±0.18 μg / kg /h in second group , (р=0.032). The pain level by VAS in patients in both groups, in average, did not exceed 4 points within the first post-operative day, and there was no need in life-saving analgesia with narcotic analgetics.\n\n\nCONCLUSION\nConclusion: The USG- TAP-blockade has analgetic and opioid-sparing advantages in MO patients undergoing laparoscopic surgery in the lower abdomen and in the pelvis and may be a part of the efficient multimodal analgesia within ERAS in that patient s group.