Transversus Abdominus Plane Block for Laparoscopic Sleeve Gastrectomy-A Systematic Review and Meta-analysis of Randomized Clinical Trials

Background: Transversus abdominus plane (TAP) blocks have become increasingly popular, due to a perceived reduction in post-operative pain following laparoscopic surgery. Their value following sleeve gastrectomy remains unclear. Objectives: To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) evaluating the efficacy of TAP block in patients undergoing laparoscopic sleeve gastrectomy. Setting: Integration of data from bariatric surgery units across the world. Methods: A systematic review was performed as per PRISMA guidelines. Meta-analysis was performed using Review Manager v5.4. Results: Eleven RCTs including 776 patients were included with 338 randomized to TAP block (50.0%). A non-significant equipoise was observed between groups for mean age, gender, body mass indices, and American Society of Anesthesiologists grades (all P > 0.050). At meta-analyses, patients receiving TAP block had significantly reduced post-operative visual analogue scores (VAS) at 0-60 min (mean difference (MD), - 1.23; 95% confidence interval (CI), - 1.87 to - 0.58; P < 0.001), 2 h (MD, - 1.78; 95% CI, - 3.28 to - 0.27; P < 0.001), 4 h (MD, - 1.00; 95% CI, - 1.24 to - 0.76; P < 0.001), 6 h (MD, - 1.58; 95% CI, - 2.46 to - 0.69; P < 0.001), 12 h (MD, - 1.13; 95% CI, - 1.80 to - 0.46; P = 0.001), and 24 h (MD, - 0.77; 95% CI - 1.42 to - 0.12; P < 0.001) respectively. At meta-analysis, a non-significant difference was observed for breakthrough analgesia consumption, time to rescue analgesia, post-operative nausea and vomiting, time to ambulation, length of stay, and post-operative complications. Patient satisfaction scores were significantly in favour of TAP block (MD, 0.88; 95% CI, 0.49-1.28; P < 0.001). Conclusion: TAP block significantly reduced post-operative pain and improved patient satisfaction following sleeve gastrectomy. TAP block should be considered for patients undergoing this procedure, should expertise allow.