الفهرس 
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Abstract
Obesity is one of the greatest health challenges facing health care providers. Obesity is defined as a BMI >30 kg /m2 whereas those with a BMI >35 kg /m2 are considered morbidly obese and those with a BMI >55 kg /m2 are considered super morbid obese. The number of obese patients undergoing surgery, either bariatric or non-bariatric, is steadily increasing. The pathophysiological changes induced by obesity make these patients prone to perioperative complications immediately after the induction of GA. Atelectasis develops leading to reduction in ventilation/perfusion ratio and pulmonary compliance.
Bariatric surgery by video-laparoscopy has been used since 1994 as a less invasive procedure, thereby reducing the incidence of early and late complications compared with the conventional techniques.
The aim of bariatric surgery is to reduce the volume of the gastric cavity, resulting in the development of satiety after the ingestion of a small volume of food. The strategy to this early satiety involves creating a small gastric pouch together with a limited gastric outlet as gastric sleeve.
Lung RM as a ventilatory strategy has been used to improve gas exchange during anesthesia which consists of pulmonary inflations and sustained use of PEEP to prevent atelectasis and reduce post-operative pulmonary complications in patients undergoing laparoscopic bariatric surgery.
The aim of RM is reopening of collapsed alveolar units, increasing lung area available for gas exchange and improving arterial oxygenation in patients undergoing abdominal, thoracic or laparoscopic surgery and in patients prone to developing moderate degrees of lung injury after surgical procedures.
The treatment of postoperative pain certainly plays an important role in preservation of pulmonary function after surgery, this effect can be confirmed by the spirometry values. Despite the minimally invasive nature of laparoscopic bariatric surgery, pain can be moderate to severe in the immediate postoperative period.
TAP block has been demonstrated to improve pain-related outcomes after upper and lower abdominal surgical procedures and reduce opioid consumption after laparoscopic bariatric surgery when added to conventional analgesic techniques, trocar insertion site local anesthetic infiltration and systemic analgesia.
The aim of this work was to evaluate the impact of RM and TAP block performed during laparoscopic bariatric surgery on spirometric, ventilatory, hemodynamic variables, opioid requirements and pain score assessed after surgery.
This was a prospective randomized controlled clinical study included 80 patients undergoing laparoscopic bariatric surgery (sleeve or bypass) under GA. Patients were divided into four groups:
• group I: consists of 20 patients who received standardized postoperative analgesia regimen.
• group II: consists of 20 patients who received TAP block after intubation and before surgical incision and receive standardized postoperative analgesia regimen.
• group III: consists of 20 patients who received RM after intubation and after pneumoperitoneal exsufflation and receive standardized postoperative analgesia regimen.
• group IV: consists of 20 patients who received RM after intubation and after pneumoperitoneal exsufflation and TAP block after intubation and before surgical incision and receive standardized postoperative analgesia regimen.
Summary of our results:
• After operation FVC and FEV1 were significantly higher in group IV compared to other groups and was insignificantly different between groups I, II and III.
• Intraoperative PaO2 and PaO2/FiO2 were significantly higher in groups III, IV compared to other groups I, II .
• HR and MAP before operation and intraoperatively were insignificantly different among the four groups.
• Opioid consumption and NRS at 1, 2, 4, 6 and 12hr were significantly lower in groups II, IV compared to I, III groups.