Erdogan Mehmet A, Ozgul Ulku, Uçar Muharrem, Yalin Mehmet R, Colak Yusuf Z, Çolak Cemil, Toprak Huseyin I
Department of Anaesthesiology and Reanimation, School of Medicine, Inonu University, Malatya, Turkey.
Department of Biostatistics and Medical Informatics, School of Medicine, Inonu University, Malatya, Turkey.
Clin Transplant. 2017 Apr;31(4). doi: 10.1111/ctr.12931. Epub 2017 Mar 11.
Transversus abdominis plane (TAP) block provides effective postoperative analgesia after abdominal surgeries. It can be also a useful strategy to reduce perioperative opioid consumption, support intraoperative hemodynamic stability, and promote early recovery from anesthesia. The aim of this prospective randomized double-blind study was to assess the effect of subcostal TAP blocks on perioperative opioid consumption, hemodynamic, and recovery time in living liver donors.
The prospective, double-blinded, randomized controlled study was conducted with 49 living liver donors, aged 18-65 years, who were scheduled to undergo right hepatectomy. Patients who received subcostal TAP block in combination with general anesthesia were allocated into Group 1, and patients who received general anesthesia alone were allocated into Group 2. The TAP blocks were performed bilaterally by obtaining an image with real-time ultrasound guidance using 0.5% bupivacaine diluted with saline to reach a total volume of 40 mL. The primary outcome measure in our study was perioperative remifentanil consumption. Secondary outcomes were mean blood pressure (MBP), heart rate (HR), mean desflurane requirement, anesthesia recovery time, frequency of emergency vasopressor use, total morphine use, and length of hospital stay.
Total remifentanil consumption and the anesthesia recovery time were significantly lower in Group 1 compared with Group 2. Postoperative total morphine use and length of hospital stay were also reduced. Changes in the MAP and HR were similar in the both groups. There were no significant differences in HR and MBP between groups at any time.
Combining subcostal TAP blocks with general anesthesia significantly reduced perioperative and postoperative opioid consumption, provided shorter anesthesia recovery time, and length of hospital stay in living liver donors.
腹横肌平面（TAP）阻滞可为腹部手术后提供有效的术后镇痛。它也是减少围手术期阿片类药物消耗、维持术中血流动力学稳定以及促进麻醉后早期恢复的一种有效策略。这项前瞻性随机双盲研究的目的是评估肋下TAP阻滞对活体肝供者围手术期阿片类药物消耗、血流动力学和恢复时间的影响。
对49例年龄在18 - 65岁、计划行右半肝切除术的活体肝供者进行了这项前瞻性、双盲、随机对照研究。接受肋下TAP阻滞联合全身麻醉的患者被分配到第1组，仅接受全身麻醉的患者被分配到第2组。在实时超声引导下成像，双侧进行TAP阻滞，使用用生理盐水稀释的0.5%布比卡因，总量达到40 mL。我们研究的主要结局指标是围手术期瑞芬太尼的消耗量。次要结局指标包括平均血压（MBP）、心率（HR）、平均地氟醚需求量、麻醉恢复时间、急救血管升压药的使用频率、吗啡总用量以及住院时间。
与第2组相比，第1组瑞芬太尼总消耗量和麻醉恢复时间显著更低。术后吗啡总用量和住院时间也有所减少。两组的平均动脉压（MAP）和心率变化相似。两组在任何时间的心率和MBP均无显著差异。
肋下TAP阻滞联合全身麻醉可显著减少活体肝供者围手术期和术后阿片类药物的消耗，缩短麻醉恢复时间和住院时间。
