Systemic lidocaine versus ultrasound-guided transversus abdominis plane block for postoperative analgesia: A comparative randomised study in bariatric surgical patients

Background and Aims: The multimodal analgesia strategies to minimise opioid-related side effects are highly desirable in bariatric surgical procedures. We evaluated the efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block and intravenous lidocaine for postoperative analgesia in obese patients undergoing laparoscopic bariatric surgery. Methods: We studied 56 patients with body mass index >35 kg/m(2). They were randomly allocated to Lidocaine group (Group A) and USG-TAP group (Group B). Group A patients were given intravenous Lidocaine (1.5 mg/kg) bolus followed by (1.5 mg/kg/h) infusion. Group B patients were given ultrasound-guided bilateral TAP block using 20 cc of 0.375% ropivacaine each side. Postoperative numeric rating pain scale score (NRS) hours were compared. Other parameters compared were total fentanyl requirement, sedation score, postoperative nausea vomiting (PONV) score and patient satisfaction score. A P value < 0.05 was considered statistically significant. Results: The patient in the Group A had lower resting NRS score (P < 0.05) postoperatively and less fentanyl consumption (P < 0.001) than in Group B. The difference in the sedation scores (P = 0.161) and PONV (P = 0.293) score was found to be statistically insignificant between Group A and B. The difference between the two groups was statistically significant with respect to patient satisfaction score with majority of patients having an excellent patient satisfaction score in Group A as compared to Group B. Conclusion: Intravenous Lidocaine as part of multimodal analgesic technique in obese patients undergoing laparoscopic bariatric surgery improves pain score and reduces opioid requirement as compared to USG-TAP Block.