Brief Article
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World J Gastrointest Surg. Feb 27, 2014; 6(2): 27-32
Published online Feb 27, 2014. doi: 10.4240/wjgs.v6.i2.27
Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study
Gildasio S De Oliveira Jr, Paul Fitzgerald, Shireen Ahmad, John Kim, Rohit Rahangdale, Robert McCarthy
Gildasio S De Oliveira Jr, Paul Fitzgerald, Shireen Ahmad, Rohit Rahangdale, Robert McCarthy, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
John Kim, Department of Surgery, Northwestern University, Chicago, IL 60611, United States
Author contributions: De Oliveira Jr GS and McCarthy R analysed data; De Oliveira Jr GS and Fitzgerald P contributed to conduct of the study; De Oliveira Jr GS, Ahmad S, Rahangdale R and McCarthy R participated in study design and manuscript preparation; Kim J amd Fitzgerald P participated in manuscript preparation.
Supported by Department of Anesthesiology, Northwestern University
Correspondence to: Gildasio S De Oliveira Jr, MD, MSCI, Associate Chair for Research, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron, St F5-704, Chicago, IL 60611, United States. g-jr@northwestern.edu
Telephone: +1-312-4733573 Fax: +1-312-4733573
Received: September 16, 2013
Revised: November 21, 2013
Accepted: January 13, 2014
Published online: February 27, 2014
Abstract

AIM: To estimate an effect size for the transversus abdominis plane (TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery.

METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40 (QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test.

RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range (IQR)] of 175.5 (170-189) compared to 170 (160-175) in the control group (P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median (IQR) of 7.5 (2.5-11.5) mg iv morphine equivalents compared to 13 (7-21.5) in the control group (P = 0.07). Correlation analysis (Spearman’s Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores, -0.49 (P = 0.03).

CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.

Keywords: Transversus abdominis plane, Infiltration, Gastric band, Pain, Recovery

Core tip: In this current randomized, double blinded, placebo controlled pilot study we estimated the effect of a transversus abdominis plane block on postoperative quality of recovery in morbidly obese patients undergoing laparoscopic gastric band surgery. Postoperative opioid consumption was inversely correlated to quality of recovery in this surgical population. The transversus abdominis plane block seems to be an effective strategy to improve quality of recovery in those patients.