Postoperative Analgesia of TAP Block for Laparoscopic Sleeve Gastrectomy

Study Overview
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Brief Summary
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many methods were considered to control postoperative pain in laparoscopic bariatic surgery including non steroidal anti-inflammatory drugs, opioids and neuraxial block but subcostal (TAP) block has provided good analgesic effect when used as a part of multimodal analgesia in bariatric surgery due to lack of visceral block

Detailed Description
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Since long time opioid have been used to control postoperative pain in bariatric surgery However, an increasing awareness of opioid-related adverse events, including respiratory depression, paralytic ileums, and sedation, constipation has led to a shift towards utilizing opioid-sparing techniques for postoperative analgesia As neuroaxial block and ultrasound guided nerve blocks As the transverse abdominis plane (TAP) block which is of increasing interest nowadays (Basaran B, et al 2015) The ultrasound-guided oblique SCTAP block, first described by Hebbard et al., has the potential to provide analgesia for both upper and lower abdominal surgery. There is a growing consensus that the SCTAP block provides better analgesia for upper abdominal incisions The TAP block via various approaches provides some advantages over neuraxial anesthesia (Ganapathy Set al 2015). For example, TAP blocks are associated with a lower use of intraoperative phenylephrine and a lesser degree of intraoperative blood pressure changes. The SCTAP block may be utilized in cases in which neuraxial anesthesia is contraindicated, such as patients with coagulation issues or infection at the epidural puncture site. Although the SCTAP block provides sensory blockade of the abdominal wall, it is lacking in coverage of visceral pain (Lissauer J,et al 2014). The lack of visceral pain analgesia may require the use of additional methods of postoperative pain control such as intravenous opioids or non-narcotic analgesics.

Official Title
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Postoperative Efficacy of Subcostal TAP Block in Laparoscopic Sleeve Gastrectomy Surgery: a Randomized Controlled Trial

Conditions
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Postoperative Pain

Intervention / Treatment
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* Other: subcostal TAP block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 20-60 years ASA Ι-ΙΙ BMI >35 Exclusion Criteria: Patient refusal. Allergy to study drugs. Infection at site of injection.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: TAP group<br>patients candidate for laparoscopic sleeve gastrectomy to receive GA and subcostal TAP block to control postoperative pain and minimize opioid consumption | Other: subcostal TAP block<br>* Comparison between subcostal TAP block and opioids for postoperative pain after laparscopic sleeve gastrectomy<br>|
| No Intervention: Control group<br>healthy controls candidate for laparoscopic sleeve gastrectomy to receive GA only opioids were used | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain control | by using VAS score | 9 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative 24 hour opioid consumption | collecting total doses of opioids consumed in the first 24 hours postoperative in cmparison to the other group | 9 months | 
| postoperative nausea and vomiting | recording incidence, frequency and severity | 9 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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subcostal TAP, laparoscopic, sleeve gastrectomy