Transversus Abdominis Plane Block with Liposomal Bupivacaine and its Effect on Opiate Use after Weight Loss Surgery: A Randomized Controlled Trial

Abstract Background Liposomal bupivacaine as an extended-release local anesthetic may provide lasting pain control and therefore decrease the need for narcotics in the immediate postoperative period. Objectives The aim of this study was to evaluate whether Transversus Abdominis Plane (TAP) block with liposomal bupivacaine (LB) decreased the use of postoperative narcotics compared to regular bupivacaine (RB) and no TAP block (NB) in patients undergoing weight loss surgeries. Setting A large, metropolitan, university-affiliated, tertiary hospital Methods Patients undergoing laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, or sleeve to bypass conversion over 1 year were randomized to receive TAP block using liposomal bupivacaine, TAP block with regular bupivacaine or no block in a double-blind, randomized controlled trial. The outcomes measured were postoperative use of opiates, pain score, length of stay, time to ambulation, nausea. Data was analyzed using Chi-Squared test and Analysis of Variance(ANOVA) F-test. Results 219 patients were included in the study. Fentanyl patient-controlled analgesia usage was not significantly different between the groups (LB 351.4 v RB 360.7 v NB 353.9, p=0.97) at 48 hours post-operation. The pain scores (scale 1-10) were similar among the groups with the mean for the LB group at 4.3, and RB and NB groups both at 4.7(p=0.35). The type of block or lack of block did not significantly impact the length of stay, time to ambulation, or presence of nausea. Conclusion The LB TAP block did not significantly reduce the total opiate pain medication consumption nor did it reduce pain scores among bariatric surgery patients.