Improving Perioperative Pain in Bariatric Surgery Patients with use of Transversus Abdominis Plane (TAP) Blocks
Purpose: The purpose of this study was to examine the efficacy of preoperative TAP blocks relative to standard intravenous analgesia (usual care [UC]) in reducing total morphine milliequivalents (opioid use) throughout the perioperative continuum of care among a sample of bariatric surgery patients. Background: Pain remains an issue for patients after metabolic and bariatric surgery. Opioids have been the standard of care for decades but are not without risks and side effects. Innovative methods of pain control are needed for those undergoing bariatric surgery. Methods: A retrospective data analysis design was used for this study. Patients undergoing weight loss surgery were categorized into two groups: (1) patients using standard intravenous analgesia (UC) and (2) patients using preoperative ultrasound-guided TAP block. Findings: The study sample consisted of 24 male and 121 female patients who had previously undergone weight loss surgery (90.3% elected laparoscopic sleeve gastrectomy while 9.7% elected Roux en Y gastric bypass) by one of two bariatric surgeons at a single facility from August 2019 through February 2020. Overall opioid use was lower in the TAP block group (16.98 ±10.86) compared to UC (20.16 ± 14.52; total MME ranging from 0 to 73, F = .2.89 [df =1], p=.09). Hospital length of stay measured in hours was lower in the TAP block group (32.88 ±7.89) compared to UC (37.16 ±10.93), ranging from 25 to 75 hours (F=7.93 [df =1], p=.006). The Defense and Veterans Pain Rating Scale (DVPRS) was used to assess the patients’ pain level throughout the perioperative period. Patients’ self-reported pain scores ranged from 0 (No Pain) to 10 (As bad as it could be; nothing else matters). Pain scores were lower in the TAP block group (mean 3.44 +1.34) than in the UC group (mean 3.76+1.38) ranging from 0 to 7 (F = .125 [df =1], p=.72). Implications: Although mean pain scores and total MME between groups did not indicate statistical significance, decreased pain scores and MME is clinically significant in the era of the opioid epidemic.
pain management; transversus abdominis plane block; bariatric surgery, Perioperative, Operating Room and Surgical Nursing
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