Gildasio S De Oliveira Jr, Paul Fitzgerald, Shireen Ahmad, Rohit Rahangdale, Robert McCarthy, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States.
World J Gastrointest Surg. 2014 Feb 27;6(2):27-32. doi: 10.4240/wjgs.v6.i2.27.
To estimate an effect size for the transversus abdominis plane (TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery.
The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40 (QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test.
Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range (IQR)] of 175.5 (170-189) compared to 170 (160-175) in the control group (P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median (IQR) of 7.5 (2.5-11.5) mg iv morphine equivalents compared to 13 (7-21.5) in the control group (P = 0.07). Correlation analysis (Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores, -0.49 (P = 0.03).
The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.
评估腹横肌平面（TAP）浸润对腹腔镜胃带手术患者恢复质量的影响大小。
该初步研究为随机、双盲、安慰剂对照试验。接受腹腔镜胃带手术的患者随机分为接受双侧 TAP 浸润 20 毫升 0.5%罗哌卡因或生理盐水。评估的结果包括术后 24 小时的恢复质量-40（QoR-40）、术后阿片类药物消耗和疼痛。使用曼-惠特尼 U 检验检查数据。
共招募了 19 名受试者。与对照组（170 [160-175]）相比，接受 TAP 浸润组在术后 24 小时的总体 QoR-40 评分中呈阳性趋势，中位数（四分位距 [IQR]）为 175.5（170-189）（P = 0.06）。TAP 浸润组的累积阿片类药物消耗也呈下降趋势，中位数（IQR）为 7.5（2.5-11.5）mg iv 吗啡当量，而对照组为 13（7-21.5）mg（P = 0.07）。相关性分析（Spearman's Rho）显示，24 小时累积阿片类药物消耗与总体 QoR-40 评分呈负相关，-0.49（P = 0.03）。
在接受胃减少手术的病态肥胖患者中，使用多模式镇痛技术减少阿片类药物相关副作用尤其可取。TAP 浸润似乎在减少术后阿片类药物消耗和改善病态肥胖患者腹腔镜胃带手术后的恢复质量方面具有临床重要意义。未来有必要进一步研究证实 TAP 浸润对这些患者的有益作用。
