Nausea and vomiting are a major complication following surgery. The bariatric population is at higher risk of experiencing post-operative nausea and vomiting (PONV). Incorporating drugs that act on different receptors, known as multimodal anesthesia, has been shown to reduce the risk of PONV in the bariatric population. An example of multimodal anesthesia is the use of local anesthetic injections (regional anesthesia) to reduce pain, therefore reducing risk of PONV. Transversus Abdominis Plane (TAP) block is an example of regional anesthesia, which consists of an injection of local anesthetic into the lateral abdominal muscles. The addition of a TAP block to an implemented Enhanced Recovery After Surgery (ERAS) program incorporates multimodal anesthesia, which may allow for a reduction in narcotic requirement, therefore leading to a reduction in PONV. The purpose of this systematic review was to evaluate the current literature and outcomes of opioid use with the addition of the TAP block on the incidence of PONV. PRISMA guided the search for relevant studies and the CASP checklist was used for the critical appraisal. A cross study analysis was performed to compare the studies. Results demonstrated that the addition of the TAP block to the ERAS protocol for the bariatric surgical population was associated with significantly lower amount of PONV, better pain control with less opioid administration, a comparable decrease in time to ambulation, and less time to tolerating a full liquid diet. Anti-emetic requirement and dosing varied between studies.
