Transversus Abdominis Plane (TAP) Block in Laparoscopic Gastric-bypass Surgery

Phase 3

Completed

Brief Summary: Laparoscopic gastric-bypass surgery (LGBS) is one of the surgical treatments for morbid obesity, which is performed under general anesthesia. TAP block is an analgesic strategy covering the dermatomes from T6 to L1 and consists of injecting local anesthetic in the TAP between the costal margin and the iliac crest, where the thoracolumbar nerves (T6-L1) are located. As far as the investigators know, this analgesic technique has never been studied in LGBS. The investigators objective is to determine whether an ultrasound (US)-guided TAP block provides improved analgesia during the first 24 hours after laparoscopic gastric-bypass surgery, compared to conventional therapy only.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

contraindications to regional blockade (e.g., allergy to local anesthetics, coagulopathy, malignancy or infection in the area)
pregnancy
history of alcohol or drug dependence/abuse
history of long term opioid intake or chronic pain disorder
history of significant psychiatric conditions that may affect patient assessment
inability to understand the informed consent and demands of the study

Arm && Interventions

Group	Intervention	Description
Conventional management	Conventional Managment	On the ward, patients will be prescribed acetaminophen 1 g every 6 hours. If additional analgesia is required, patients will take oxycodone 5-10 mg up to every 2 hours or iv morphine. Patients with contraindications to oxycodone will be prescribed oral hydromorphone 1-2 mg instead. This is the current standard of care at Toronto Western Hospital.
TAP Block+Conventional Management	TAP-Block	The TAP block will be performed after the induction, before the surgery, by an anesthesiologist with experience of at least 10 successful TAP blocks.Also patients will be prescribed acetaminophen 1 g every 6 hours. If additional analgesia is required, patients will take oxycodone 5-10 mg(oral hydromorphone 1-2 mg) up to every 2 hours or iv morphine.

Primary Outcome Measures

Name	Time	Method
Opioid consumption over the first 24 hours following LGBS.	24 hrs	Opioid consumption will be expressed in terms of milligrams doses of PO morphine. If other opioids are used, doses will be converted to the equivalent PO morphine dose using standard opioid dosage conversion tables.

Secondary Outcome Measures

Name	Time	Method
Duration of block	48 hours	starting after block administration till drop in sensory block injection
Pain scores	48 hours	Measured with a visual analogue scale (VAS, from 0 to 10), in the postoperative care unit, at rest and on movement (coughing).
Block procedure time	30 minutes	the time from placement of the ultrasound probe on the patient on one side to withdrawal of the needle on the other side;
Opioid consumption at 48 hours	48 Hours	Opioid consumption expressed as milligram doses of PO morphine in the postoperative care unit and at 48 hours.If other opioids are used, doses will be converted to the equivalent PO morphine dose using standard opioid dosage conversion tables
incidence of itching, and number of antipruritic medication administrations	48 hours
TAP block complications	48 hours	vascular puncture, intravascular local anesthetic injection and local hematoma;
incidence of nausea and vomiting, and number of antiemetic medication administrations	during hospital stay average of 2 - 3 days

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