Analgesic Efficacy and Outcome of Lumber Epidural Analgesia versus ultrasound guided Trasversus Abdominis Plane block In Laparoscopic Sleeve Gastrectomy

Background: The transversus abdominis plane (TAP) block provide effective postoperative analgesia in lower abdominal surgery. Subcostal TAP block as a new technique to provide analgesia for the supraumbilical abdomen. Traditionally, pain relief for these patients is provided by epidural analgesia or IV opioid analgesia. Although epidural analgesia is currently the “gold standard” for postoperative pain treatment, associated complications and contraindications may limit its use. IV opioid analgesia may cause opioid-related side effects and be associated with inadequate analgesia. Aim of the Work: This study aimed at clinically evaluating and statistically comparing between lumber epidural versus transversus abdominus plane block as postoperative Analgesia for laparoscopic sleeve gastrectomy. Also, our goal was to figure out the most possible effective technique for this kind of procedure with most benefits and least side effects. Patients and Methods: This single blinded randomized clinical trial was carried out at Ain Shams University hospitals on 60 adult Bariatric patients undergoing elective Laparoscopic sleeve Gastrectomy, aged 20 to 50 years, ASA I-II, BMI equal or less than 45 Kg/m2. Results: Patients in the Lumber Epidural group had significantly less pain score when compared to the other TAP group (p-value < 0.001). And, they had longer time to first request rescue analgesia (nalbuphin) (P = 0.0013). Also, total dose of nalbuphin consumption was less in Lumber Epidural group than TAP group (P < 0.001). Conclusion: This study concluded that TAP block was effective in pain relief after Laparoscopic sleeve gastrectomy, however, Lumber Epidural was superior in pain relief, less narcotic consumption and overall more patient satisfaction.