Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG): A double-blind randomized controlled trial.

BACKGROUND: The aim of this randomized controlled trial was to assess the effectiveness of transversus abdominis plane (TAP) block in post-operative pain management in patients undergoing laparoscopic sleeve gastrectomy (LSG). METHODS: Ninety consecutive patients undergoing LSG were randomly assigned to three groups: placebo, TAP block with 0.25% bupivacaine (40mL total), and TAP block with 0.25% bupivacaine + 1/100,000 epinephrine (40mL total). Pain and nausea/vomiting scores were evaluated at varying times until discharge. Other parameters included, additional analgesia required, time to ambulation, length of stay and time required for return to work after discharge. RESULTS: There was decrease in post-operative pain 3 hours after surgery between the placebo group and the bupivacaine group and between the placebo group and the bupivacaine with epinephrine group, however, no difference in 1, 6, 12 and every 6 hours after. There was no significant difference in post-operative analgesia requirements, nausea/vomiting scores, time to ambulation, hospital length of stay, or time to return to work after discharge. CONCLUSION: The efficacy of TAP block is not apparent likely due to the ERAS protocol set in place for bariatric surgery, which already targets early postoperative pain control and mobility.

Ultrasensitive detection of KRAS2 mutations in bile and serum from patients with biliary tract carcinoma using LigAmp technology.

Patients with biliary tract carcinoma have a poor prognosis. Early detection efforts are urgently needed to ameliorate the dismal prognosis for these patients. Mutations of the KRAS2 gene are one of the most common genetic aberrations in this cancer. In this study, we used LigAmp, an ultrasensitive technology for detecting point mutations, to analyze KRAS2 mutations in patients with a variety of neoplastic and non-neoplastic pancreatobiliary diseases. DNA was isolated from 64 samples, including 44 bile samples and 20 serum samples. Oligonucleotides specific for KRAS2 G35A (GAT, G12D), G35T (GTT, G12V), and G34A (AGT, G12S) mutations were used. KRAS2 mutations were detected in 14 of 16 (87.5%) neoplastic bile samples and in 9 of 28 (32.1%) non-neoplastic bile samples. However, the mutation levels were significantly lower in the non-neoplastic bile (median = 0.4%) compared with those in the neoplastic bile (median = 5.1%). KRAS2 mutations were also detected in 9 of 11 (81.8%) serum samples from patients with biliary tract carcinoma, which was further confirmed by cloning BstN1-refractory PCR products and DNA sequencing. However, KRAS2 mutations were not present in the sera from eight patients with benign pancreatobiliary diseases. These data demonstrate that KRAS2 mutations are detectable in both bile and serum using LigAmp. This technology has the potential for early biliary tract carcinoma detection and possibly for residual disease monitoring post-therapy.