Background

Pain management with opioids not only increase addiction risk but may also delay recovery from associated side-effects (nausea, vomiting, respiratory depression). An enhanced recovery after surgery (ERAS) protocol with multimodal analgesia (MMA) reduces pain, opioid use and side-effects. Recent studies suggest that the incorporation of an ultrasound-guided TAP block into a MMA regimen under ERAS is efficacious for pain reduction and recovery. The purpose of this study was to determine the effects of TAP block, as part of MMA, on postoperative opioid requirement and surgery recovery.

Methods

The study included 145 bariatric patients (69 TAP-block, 74 Non-TAP block), all of whom were under an ERAS protocol and identical MMA regimen. Assessments were: 24-hr opioid use (morphine equivalents) and opioid-use categories (none, low, moderate, high), patient characteristics, co-morbidities, surgical times, intra-op complications, length of stay (LOS), and 30-day readmissions/re-operations. Data was analyzed using parametric and non-parametric statistics with p<0.05.

Results

Age, BMI, gender, co-morbidities (incidence/number), and surgery type did not significantly (p>0.05) differ between the intervention groups. Operative times were also similar and there were no differences in intra- or postoperative complications or readmissions. Neither 24-hr morphine equivalents (5.07+-0.97 vs. 6.79+-1.36, TAP-block vs. Non-TAP block, respectively) nor percentage of patients within each of the opioid-use categories differed significantly. LOS was reduced (p<0.001 with TAP-block (1.19+-0.05 vs. 1.35+-0.03) but unrelated to opioid use (p>0.05).

Conclusions

Our findings suggest that TAP-block may have no additive effect to pain management provided by our ERAS-MMA protocol as regards opioid use but may facilitate recovery.