Randomized single blind trial to compare the short term post-operative outcome and cost analysis of laparoscopic versus ultrasound guided transversus abdominis plane block in patients undergoing bariatric surgery

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Abstract
Introduction Laparoscopic Bariatric surgery despite being minimally invasive can cause moderate to severe pain in the immediate postoperative period. Adequate pain management remains a major challenge. Transversus Abdominis Plane (TAP) block is a regional anesthesia technique which blocks the sensory nerve supply of anterior-lateral abdominal wall. Aims and objectives Primary: evaluate Laparoscopic versus ultrasound (USG)-guided TAP block on immediate post-operative analgesia after undergoing laparoscopic bariatric surgery. Secondary: compare cost effectiveness of Laparoscopic versus ultrasound-guided TAP block after undergoing bariatric surgery. Materials and methods Randomized Single blind study undertaken after sample size was calculated by (N) = 2(Zα + Z1-β)2σ2/δ2 which proposed 60 patients in each group. Block randomization was done after excluding redo/revision surgeries and patients were alloted Group I: Laparoscopic-guided TAP block & Group II: USG-guided TAP block. In both groups, Bilaterally, 20 ml (0.25%) bupivacaine was injected immediately after completion of bariatric surgery. SPSS v23 (IBM Corp.) was used for analysis. Results Group I (N = 61 53F/8 M) & Group II (N = 60 42F/18 M) were demographically comparable. Group I (3.58 ± 0.67) had significantly lower procedure time compared to Group II (12.47 ± 1.61) (p-Value < 0.001). First rescue analgesia was administered at 7.07 ± 2.61 h in Group I vs 7.21 ± 2.39 h in Group II (p-Value 0.659). In first 24 h rescue analgesic dose requirement in Group I was 1.29 ± 0.53 vs 1.39 ± 0.50 in Group II (p-Value 0.487). VAS scores during rest and movement till 24 h post-operative were statistically similar. Procedural cost was more in group II. Conclusion Laparoscopic-guided TAP block is a safe and cost-effective approach for postoperative pain management after bariatric surgery and provides similar comparable analgesic effect as the USG-TAP block. Laparoscopic TAP is a surgeon delivered, easy to administer and significantly less time-consuming procedure which is feasible even when an ultrasound machine is not available.

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