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Single-Shot Regional Anesthesia for Bariatric Surgery: a Systematic Review and Network Meta-Analysis

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Abstract

Purpose

Laparoscopic bariatric surgeries can cause intense postoperative pain. Opioid medication can alleviate the pain but can have harmful side effects especially in patients with obstructive sleep apnea. To promote early recovery, enhanced recovery after surgery guideline advises minimizing opioid use and opting for alternative analgesics. This paper aims to investigate the effect of regional anesthesia techniques through a systematic review and network meta-analysis. Primary outcome is postoperative morphine equivalent consumption at 24 h.

Methods

Search was conducted in the following databases: PubMed, CENTRAL, Scopus, and EMBASE, from the inception until 10 January 2023. The eligibility criteria were determined by PICOS, including postoperative opioid consumption, pain scores, time to ambulate, use of additional analgesics, and adverse events. The quality assessment was performed using the Risk of Bias 2 Tool, and the certainty of evidence was assessed using the GRADE approach. Funnel plots were used to evaluate publication bias.

Results

We included 22 studies in quantitative synthesis. A review of 12 studies found that all techniques had a lower mean consumption of opioids compared to placebo or no intervention, with TAP block having the greatest reduction. The quality of evidence for postoperative pain, PONV, time to deambulate, and use of rescue analgesics, was rated as moderate, with TAP block being the most effective intervention. There was no publication bias in any outcome.

Conclusions

TAP block is superior to other regional anesthesia techniques in reducing opioid consumption, pain, PONV, and use of rescue analgesics in bariatric surgery. However, further research is needed.

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Author information

Authors and Affiliations

  1. UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy

    Alessandro De Cassai, Greta Paganini, Tommaso Pettenuzzo, Francesco Zarantonello, Annalisa Boscolo, Michele Carron & Paolo Navalesi

  2. UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy

    Annalisa Boscolo, Michele Carron & Paolo Navalesi

  3. Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy

    Annalisa Boscolo

  4. Department of Anesthesiology and Reanimation, Faculty of Medicine, Samsun Training and Research Hospital, Samsun University, Samsun, Turkey

    Serkan Tulgar

  5. UOC Anesthesia and Intensive Care Unit Sant’Antonio, University Hospital of Padua, Padua, Italy

    Marina Munari

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  1. Alessandro De Cassai
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Correspondence to Alessandro De Cassai.

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Key points

• Laparoscopic bariatric surgeries are considered minimally invasive; however, they could be associated with intense postoperative pain.

• Several regional anesthesia techniques have been proposed to reduce opioid consumption in laparoscopic bariatric surgeries.

• All regional anesthesia techniques were effective in reducing pain in patients undergoing laparoscopic bariatric surgeries.

• TAP block was the most effective technique in reducing opioid consumption, postoperative pain at 6 and 12 h, time to ambulate, and use of additional analgesics.

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De Cassai, A., Paganini, G., Pettenuzzo, T. et al. Single-Shot Regional Anesthesia for Bariatric Surgery: a Systematic Review and Network Meta-Analysis. OBES SURG 33, 2687–2694 (2023). https://doi.org/10.1007/s11695-023-06737-6

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  • DOI: https://doi.org/10.1007/s11695-023-06737-6

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