Background

Transversus abdominus plane (TAP) blocks are regional anesthesia adjuncts utilized in surgery to optimize analgesia. The ideal timing of administration of TAP blocks in laparoscopic sleeve gastrectomy has not been established.

Methods

A total of 200 patients undergoing LSG were prospectively randomized and divided into two equal groups having a TAP block at the beginning (Early) or at the end (Late) of the operation. The primary outcome measure was numerical pain assessment upon arrival to the post-anesthesia care unit and at 4, 8, 12, 16, 20, and 24 hours postoperatively.

Results

The entire study population had a mean age of 43 and mean BMI of 46. The majority were female (89.5%) and identified as White (60%). The two groups were well matched in nearly all baseline characteristics. No differences in non-opioid analgesic use or hospital length of stay were observed. There was a similar reduction in pain scores for both groups the longer time elapsed from surgery. No significant differences in pain scores between groups were identified at any time point however there was a trend for lower pain scores 24 hours postoperatively in the Late group (1.35 ± 3.5 vs. 1.91 ± 2.5; p = 0.08). More patients in the Early group received intravenous morphine for analgesia than in the Late group (7% vs 1%; p = 0.032) however there was no difference in overall morphine milligram equivalents used.

Conclusions

The timing of administration of TAP blocks does not appear to impact post-operative pain for LSG.