Surgery Meets Comfort: Study assessed Advanced Pain Relief Strategies After Gastric Resection

Written by Dr Monish Raut Published On 2025-08-07T21:00:02+05:30 | Updated On 7 Aug 2025 9:00 PM IST

Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery

Gastric surgery, encompassing procedures like gastric resection for diverse indications such as tumors, ulcers, pyloric obstruction, and severe obesity, is increasingly prevalent worldwide. Enhanced recovery after surgery (ERAS) protocols emphasize multimodal postoperative pain management, including epidural anesthesia, transversus abdominis plane (TAP) block, and local infiltration anesthesia to enhance patient recovery. Among these modalities, TAP block, introduced by Rafi in 2001, involves injecting local anesthetic into the fascial plane between the transversus abdominis and internal oblique muscles to inhibit abdominal wall nerve conduction, thereby diminishing postoperative pain and opioid consumption while improving patient satisfaction. Despite demonstrating efficacy in various abdominal surgeries, its effectiveness in gastric procedures, including cancer and bariatric surgeries, lacks substantial evidence.

Efficacy of TAP Block in Gastric Surgeries: Findings and Clinical Implications

Recent study examines the efficacy of TAP block in gastric surgeries through meta-analysis, highlighting its ability to reduce postoperative pain within 48 hours post-surgery. The findings suggest that TAP block significantly lowers Visual Analog Scale (VAS) scores compared to control groups postoperatively, particularly in laparoscopic procedures where the effects were more pronounced. However, in traditional open surgeries, although pain reduction was observed, the clinical significance did not meet the minimal clinically important difference (MCID) threshold. Moreover, TAP block notably decreased postoperative morphine consumption, leading to potential reductions in adverse effects like nausea and promoting early ambulation and intestinal recovery.

Subgroup Analyses and Considerations for TAP Block in Gastric Surgeries

Subgroup analyses based on surgery type, TAP technique, and control measures confirmed the analgesic efficacy of TAP block within 48 hours postoperatively across different surgical approaches. While some studies indicated that TAP block did not significantly outperform opioids or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in certain scenarios, caution is advised due to limited study numbers in specific subgroups. The meta-analysis also revealed heterogeneity among studies, attributed to variations in TAP block techniques, control interventions, and patient demographics, necessitating well-designed randomized controlled trials for validation and comparison with conventional analgesics.

Implications of TAP Block in Enhancing Recovery Post-Gastric Surgery

Despite limitations like study heterogeneity and varying control group interventions, the findings underscore TAP block's potential in improving pain management, reducing opioid consumption, facilitating early mobilization, and enhancing patient recovery post-gastric surgery. Further research is needed to address methodological inconsistencies and validate these results across broader patient populations and surgical settings before widespread implementation in clinical practice.

Key Points

- Gastric surgery is increasingly common globally for various conditions like tumors, ulcers, pyloric obstruction, and severe obesity. - Enhanced recovery after surgery (ERAS) protocols advocate for multimodal postoperative pain management, including techniques like transversus abdominis plane (TAP) block to enhance patient recovery.

- TAP block involves injecting local anesthetic between abdominal muscles to reduce postoperative pain, opioid use, and improve patient satisfaction, but its effectiveness in gastric surgeries lacks robust evidence.

- Meta-analysis shows that TAP block significantly reduces postoperative pain scores within 48 hours, particularly in laparoscopic procedures, but its clinical significance in traditional open surgeries may not meet the minimal clinically important difference (MCID) threshold.

- Subgroup analyses confirm TAP block's analgesic efficacy in gastric surgeries postoperatively, with variations in outcomes based on surgery type, technique, and control measures, suggesting the need for well-designed trials for validation.

- TAP block has potential in improving pain management, reducing opioid consumption, promoting early mobilization, and enhancing patient recovery post-gastric surgery, but further research is necessary to address study heterogeneity and validate results across broader patient populations and surgical settings before widespread adoption in clinical practice.

Reference –

Hao Zhang et al. (2025). Efficacy Of Transversus Abdominis Plane Block For Gastric Surgery: A Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03097-9

Transversus abdominis plane (TAP) blockGastric surgeryPostoperative pain scoresOpioid consumptionAmbulation

Dr Monish Raut

MBBS, MD (Anaesthesiology), FNB (Cardiac Anaesthesiology)

Dr Monish Raut is a practicing Cardiac Anesthesiologist. He completed his MBBS at Government Medical College, Nagpur, and pursued his MD in Anesthesiology at BJ Medical College, Pune. Further specializing in Cardiac Anesthesiology, Dr Raut earned his FNB in Cardiac Anesthesiology from Sir Ganga Ram Hospital, Delhi.