Comprehensive Multimodal Analgesia Protocol with TAP Block Reduces Postoperative Opioid Use in Bariatric Surgery.

Authors

Nicolas Cassata, Sophie Lipson, Craig Wood, Sundarachalam Pindicura, Anthony Petrick, Ryan Horsley, Vladan Obradovic, Osama Shaheen, Alexandra Falvo, Mark Mahan, David Parker

Published in

Obesity surgery. Nov 11, 2026. Epub Nov 11, 2026.

Abstract

Perioperative opioid use after bariatric surgery carries substantial risk of opioid-related harm, and multimodal analgesia (MMA) protocols limit opioids while maintaining effective pain control. We evaluated whether adding an intraoperative laparoscopic transversus abdominis plane (TAP) block to an established MMA regimen reduces inpatient and outpatient opioid use, pain scores, and 30-day perioperative outcomes.
We conducted a single-center retrospective cohort study at a high-volume MBSAQIP-accredited academic medical center of patients who underwent minimally invasive bariatric surgery from 2015 to 2024. Patients with concurrent ventral hernia repair, cholecystectomy, or preoperative opioid use were excluded. Two cohorts were compared: MMA alone (January 2015-June 2017) and MMA + TAP block (July 2017-December 2024). The primary outcome was inpatient morphine milligram equivalents (MME).
Of 2,660 patients (MMA alone, n = 618; MMA + TAP, n = 2,042), baseline characteristics were similar despite a small difference in procedure mix (p < 0.0001). The MMA + TAP cohort required fewer inpatient opioids (median MME 76 vs. 134, p < 0.0001) and had lower median inpatient pain scores (3 vs. 4, p < 0.0001). Opioid use at 12 months was lower with MMA + TAP (17% vs. 24%, p < 0.0001) and remained reduced at 36 months. Length of stay, readmissions, and emergency department visits were comparable.
A comprehensive multimodal pain regimen including laparoscopic TAP block reduced opioid use and pain scores without increasing 30-day emergency department visits or readmissions.

PMID:
43013203
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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