Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims The prevalence of obesity has risen dangerously during the last years. In addition, surgery in this type of patients has increased, including the bariatric surgery. Overweight patients usually have associated respiratory and cardiovascular disorders that will be affected with the use of opioids. Multimodal approaches, like opioid-free anaesthesia, regional anaesthesia, can help to avoid the use of opioids and their secondary effects.

Methods A 44-year-old woman was scheduled for elective laparoscopic gastric bypass. Her body mass index (BMI) was 50 kg/m2 and her medical history included asthma and obstructive sleep apnea-hypopnea syndrome. In the operating room, she was monitored with continuous electrocardiogram, pulse oximetry, non-invasive blood pressure monitoring. General anesthesia was performed, fentanyl 1mcg/kg, propofol 2mg/kg, rocuronium 0.6mg/kg. Due the possibility of difficult intubation, videolaryngoscopy was used and the patient was successfully intubated. Ultrasound guided transversus abdominis plane (TAP) block was performed bilaterally. 15ml of 0.25% bupivacaine was injected in each side. During the procedure, 2% sevoflurane was administered, and paracetamol 1 gr and ondansetron 4mg iv were given before extubation. She was extubated and taken to the recovery room, with a Visual Analog Scale score of 1.

Results Anaesthetic management in patients with morbid obesity is a challenge for anesthesiologists due the morbidities these patients have. It is recommended to apply multimodal strategies, like regional anaesthesia, that produces correct perioperative pain management.

Conclusions TAP block reduces the need for opioids, minimizing their adverse effects. This technique prevents and relieves the pain that is common after these surgeries, causing a high morbidity.