Stokes Audrey L, Adhikary Sanjib D, Quintili Ashley, Puleo Frances J, Choi Christine S, Hollenbeak Christopher S, Messaris Evangelos
1 Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania 2 Department of Anesthesiology and Perioperative Medicine, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania 3 Department of Pharmacy, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania 4 Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.
Dis Colon Rectum. 2017 Feb;60(2):170-177. doi: 10.1097/DCR.0000000000000747.
Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery.
The purpose of this study was to evaluate liposomal bupivacaine use in transversus abdominis plane blocks on postoperative pain scores and opioid use after colorectal surgery.
This was a retrospective cohort study comparing outcomes between patients receiving nonliposomal anesthetic (n = 104) and liposomal bupivacaine (n = 303) blocks.
The study was conducted at a single tertiary care center.
Patients included those identified within an institutional database as inpatients undergoing colorectal procedures between 2013 and 2015 who underwent transversus abdominis plane block for perioperative analgesia.
The study measured postoperative pain scores and opioid requirements.
Patients receiving liposomal bupivacaine had significantly lower pain scores for the first 24 to 36 postoperative hours. Pain scores were similar after 36 hours. The use of intravenous opioids among the liposomal bupivacaine group decreased by more than one third during the hospitalization (99.1 vs 64.5 mg; p = 0.040). The use of ketorolac was also decreased (49.0 vs 18.3 mg; p < 0.001). In subgroup analysis, the decrease in opioid use was observed between laparoscopic and robotic procedures but not with laparotomies. No significant differences were noted in the use of oral opioids, acetaminophen, or ibuprofen. Postoperative length of stay and total cost were decreased in the liposomal bupivacaine group but did not achieve statistical significance.
The study was limited by its retrospective, single-center design and heterogeneity of block administration.
Attenuated pain scores observed with liposomal bupivacaine use were associated with significantly lower intravenous opioid and ketorolac use, suggesting that liposomal bupivacaine-containing transversus abdominis plane blocks are well aligned with the opioid-reducing goals of many enhanced recovery protocols.
强化康复方案经常使用多模式术后镇痛来改善接受结直肠手术患者的术后结局。
本研究的目的是评估脂质体布比卡因用于腹横肌平面阻滞对结直肠手术后疼痛评分和阿片类药物使用的影响。
这是一项回顾性队列研究，比较接受非脂质体麻醉剂（n = 104）和脂质体布比卡因（n = 303）阻滞患者的结局。
该研究在一家三级医疗中心进行。
患者包括在机构数据库中确定的2013年至2015年间接受结直肠手术的住院患者，这些患者接受了腹横肌平面阻滞用于围手术期镇痛。
该研究测量了术后疼痛评分和阿片类药物需求量。
接受脂质体布比卡因的患者在术后最初24至36小时疼痛评分显著更低。36小时后疼痛评分相似。脂质体布比卡因组在住院期间静脉注射阿片类药物的使用减少了三分之一以上（99.1对64.5mg；p = 0.040）。酮咯酸的使用也减少了（49.0对18.3mg；p < 0.001）。在亚组分析中，腹腔镜手术和机器人手术之间观察到阿片类药物使用减少，但开腹手术未观察到。口服阿片类药物、对乙酰氨基酚或布洛芬的使用无显著差异。脂质体布比卡因组术后住院时间和总成本有所降低，但未达到统计学意义。
该研究受其回顾性、单中心设计以及阻滞给药的异质性限制。
使用脂质体布比卡因观察到的疼痛评分减轻与静脉注射阿片类药物和酮咯酸使用显著降低相关，表明含脂质体布比卡因的腹横肌平面阻滞与许多强化康复方案的减少阿片类药物目标一致。
