Comparing Ultrasound- and Laparoscopic-Guided Transversus Abdominis Plane (TAP) Blocks in Sleeve Gastrectomy Patients

Introduction Obesity is a major disease process in the United States with increasing prevalence and is associated with various comorbid conditions. Bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), is an effective weight loss intervention but presents challenges in postoperative pain management. This study compares the effectiveness of ultrasound-guided transversus abdominis plane (UTAP) blocks, laparoscopic-guided transversus abdominis plane (LTAP) blocks, and no regional anesthesia on overall opioid use and postoperative outcomes in LSG patients. Methods This retrospective cohort study included 1,239 obese patients who underwent LSG at a single hospital from January 2019 to June 2023. Patients were categorized into the following three groups: UTAP, LTAP, and no TAP. The primary outcome was the total morphine milligram equivalents (MME) used within the first 24 h and 48 h, and the average amount of MME during the hospital stay (all reported in median interquartile ranges). Secondary outcomes included total anesthesia time, postoperative pain scores, length of stay (LOS), 30-day readmission, and emergency room visit rates. Statistical analyses included chi-square tests, Fisher's exact test, independent t-tests, Mann-Whitney U tests, and multiple linear regression. Results The UTAP group had significantly lower median MME within the first 24 h (63 MME) compared to the LTAP group (98.8 MME, p<0.0001) and throughout the hospital stay (93 MME vs. 120 MME, p=0.0004). Both UTAP and LTAP groups had significantly lower total MME compared to the no TAP group (p<0.0001 for both). Total anesthesia time was longer for UTAP (98.5 min) compared to LTAP (92.5 min, p=0.0472). LOS was significantly longer in the UTAP group (1.59 days) compared to LTAP (1.18 days, p=0.0061). There were no significant differences in pain scores at various time points or in 30-day readmission and emergency room visit rates between the UTAP and LTAP groups. Conclusion UTAP blocks demonstrated reduced opioid use compared to LTAP and no TAP, likely due to enhanced accuracy with ultrasound guidance. Further prospective studies are warranted to confirm these findings and refine pain management strategies for bariatric surgery patients.