Laparoscopic gastric-bypass surgery (LGBS) is one of the surgical treatments for morbid obesity, which is performed under general anesthesia. TAP block is an analgesic strategy covering the dermatomes from T6 to L1 and consists of injecting local anesthetic in the TAP between the costal margin and the iliac crest, where the thoracolumbar nerves (T6-L1) are located. As far as the investigators know, this analgesic technique has never been studied in LGBS. The investigators objective is to determine whether an ultrasound (US)-guided TAP block provides improved analgesia during the first 24 hours after laparoscopic gastric-bypass surgery, compared to conventional therapy only.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
70
Block needle will be inserted out-of-plane to the ultrasound beam, perpendicular to the skin surface, until the tip lies deep between the fascia of the transversus abdominis muscle and the internal oblique muscle. 30 ml of the study solution in each side will be injected at this location and should be observed to spread in an anterior-posterior direction between two muscles. Each patient will receive a total dose of 60 ml of 0.25% bupivacaine (150 mg) + 1:200,000 epinephrine.
For these group.no TAP block administration. just conventional management for post operative pain.
Toronto Western Hospital
Toronto, Ontario, Canada
Opioid consumption over the first 24 hours following LGBS.
Opioid consumption will be expressed in terms of milligrams doses of PO morphine. If other opioids are used, doses will be converted to the equivalent PO morphine dose using standard opioid dosage conversion tables.
Time frame: 24 hrs
Pain scores
Measured with a visual analogue scale (VAS, from 0 to 10), in the postoperative care unit, at rest and on movement (coughing).
Time frame: 48 hours
Opioid consumption at 48 hours
Opioid consumption expressed as milligram doses of PO morphine in the postoperative care unit and at 48 hours.If other opioids are used, doses will be converted to the equivalent PO morphine dose using standard opioid dosage conversion tables
Time frame: 48 Hours
Duration of block
starting after block administration till drop in sensory block injection
Time frame: 48 hours
Block procedure time
the time from placement of the ultrasound probe on the patient on one side to withdrawal of the needle on the other side;
Time frame: 30 minutes
TAP block complications
vascular puncture, intravascular local anesthetic injection and local hematoma;
Time frame: 48 hours
incidence of nausea and vomiting, and number of antiemetic medication administrations
Time frame: during hospital stay average of 2 - 3 days
incidence of itching, and number of antipruritic medication administrations
Time frame: 48 hours
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