The TAP block in obese patients: pros and cons

: The growing number of laparoscopic surgical procedures performed in obese patients has increased the need to explore suitable analgesic techniques for a prone population to postoperative complications. The morbidly obese population may particularly benefit from the opioid-sparing or the opioid-free anesthesia/analgesia, which maximize the use of locoregional techniques. Transversus abdominal plane (TAP) block has been widely used as part of multimodal analgesia for abdominal and gynecological surgeries, but evidence in obese patients is still poor. The efficacy of TAP block in morbidly obese patients undergoing laparoscopic bariatric surgery is still under discussion, because ultrasound visualization of the abdominal wall muscles can be challenging due to the excessive subcutaneous fat. Inadequate needle positioning, failed regional analgesia, and possible related risks must be counterbalanced by adequate evidence of effectiveness. The present article will discuss the pros and cons of TAP block in the treatment of obese patients.