Preoperative Transversus Abdominis Plane (TAP) Block with Liposomal Bupivacaine for Bariatric Patients to Reduce the Use of Opioid Analgesics.

INTRODUCTION: Postoperative pain remains the most common challenge following inpatient and outpatient surgeries, and, therefore, opioid analgesics are widely used during the perioperative period. The aim of this study is to examine the efficiency of transversus abdominis plane (TAP) block using liposomal bupivacaine in reducing the use of opioid analgesics during the perioperative period of bariatric procedures. MATERIAL AND METHODS: A retrospective chart review was performed on 191 patients who underwent a laparoscopic bariatric procedure between September 13, 2017, and February 26, 2018. A total of 97 patients received TAP block with liposomal bupivacaine, and 94 patients did not receive TAP block. RESULTS: Baseline patient characteristics were comparable between the two groups. The mean age was 43.7 and 41.1 years, and the mean preoperative body mass index (BMI) was 45.6 and 46.1 kg/m2 in TAP and non-TAP groups, respectively. In the TAP group, 65 patients (69.2%) received intravenous (IV) hydromorphone or morphine while 93 (95.9%) did in the non-TAP group (p < 0.0001). In the TAP group, 44 (46.8%) received oral opioid analgesic while 73 (75.3%) did in the non-TAP group (p < 0.0001). The odds of receiving IV hydromorphone or morphine for TAP group was about 0.10 times the corresponding odds for non-TAP group, and the odds of receiving oral opioid analgesic for the TAP group was about 0.29 times the corresponding odds for the non-TAP group. CONCLUSION: The use of preoperative TAP block with liposomal bupivacaine significantly decreased the use of IV and oral opioid analgesics. A larger prospective study may be needed to further validate the results.

Single-center experience in single-stage conversions of gastric banding to sleeve gastrectomy: is it as safe as 2-stage conversions?

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) can be performed after obesity persistence following laparoscopic adjustable gastric banding (LAGB) with a positive safety profile. However, some argue that the conversion should be performed in 2 stages rather than 1 because of perioperative complications. The aim of this study is to determine the safety profile of single-stage LAGB to LSG conversion. SETTING: Academic hospital, United States. MATERIAL AND METHODS: From October 2009 to July 2016, a total of 76 patients underwent conversions to a LSG because of obesity persistence after LAGB. Of these cases, 65 were done as single-stage procedures and 11 were done in 2 stages. Perioperative complications were compared between the 1-stage and 2-stage conversion groups. RESULTS: Mean operative time was 122.5±26.1 minutes (range, 75-186) in the single-stage group and 103.6±29.7 minutes (range, 66-145) in the 2-stage group (P>0.08). Mean length of hospital stay was 1.5±.6 days (range, 1-3) in the single-stage group and 1.6±.7 days (range, 1-3) in the 2-stage group (sleeve gastrectomy portion) (P> .58). Two patients (3.1%) in the single-stage group required readmission within 60 days after the conversion because of dehydration (n = 1) and abdominal wall cellulitis (n = 1). Both patients were treated conservatively, and no patient in the 2-stage group required readmission within 60 days from LSG. No patient required reoperation within 60 days, and no patient developed a staple line leakage during the period of follow-up. CONCLUSION: Single-stage laparoscopic conversion of LAGB to LSG is feasible and, in appropriately selected patients, does not seem to increase the risk of complications compared with 2-stage procedures.