在腹部显微外科乳房重建术后，使用单剂量脂质体布比卡因进行腹横肌平面阻滞并联合非麻醉性疼痛治疗方案有助于缩短住院时间。
Transversus Abdominis Plane Blocks with Single-Dose Liposomal Bupivacaine in Conjunction with a Nonnarcotic Pain Regimen Help Reduce Length of Stay following Abdominally Based Microsurgical Breast Reconstruction.
作者信息
Jablonka Eric M, Lamelas Andreas M, Kim Julie N, Molina Bianca, Molina Nathan, Okwali Michelle, Samson William, Sultan Mark R, Dayan Joseph H, Smith Mark L
机构信息
New York and Great Neck, N.Y.; and Irvine, Calif.
From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai; the Department of Surgery, Division of Plastic Surgery, Mount Sinai Beth Israel Hospital; University of California, Irvine, School of Medicine; the Department of Surgery, Division of Plastic and Reconstructive Surgery, Mount Sinai West Hospital; the Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Northwell Health System.
出版信息
Plast Reconstr Surg. 2017 Aug;140(2):240-251. doi: 10.1097/PRS.0000000000003508.
BACKGROUND
Side effects associated with use of postoperative narcotics for pain control can delay recovery after abdominally based microsurgical breast reconstruction. The authors evaluated a nonnarcotic pain control regimen in conjunction with bilateral transversus abdominis plane blocks on facilitating early hospital discharge.
METHODS
A retrospective analysis was performed of consecutive patients who underwent breast reconstruction using abdominally based free flaps, with or without being included in a nonnarcotic protocol using intraoperative transversus abdominis plane blockade. During this period, the use of locoregional analgesia evolved from none (control), to continuous bupivacaine infusion transversus abdominis plane and catheters, to single-dose transversus abdominis plane blockade with liposomal bupivacaine solution. Demographic factors, length of stay, inpatient opioid consumption, and complications were reported for all three groups.
RESULTS
One hundred twenty-eight consecutive patients (182 flaps) were identified. Forty patients (62 flaps) were in the infusion-liposomal bupivacaine group, 48 (66 flaps) were in the single-dose blockade-catheter group, and 40 (54 flaps) were in the control group. The infusion-liposomal bupivacaine patients had a significantly shorter hospital stay compared with the single-dose blockade-catheter group (2.65 ± 0.66 versus 3.52 ± 0.92 days; p < 0.0001) and the control group (2.65 ± 0.66 versus 4.05 ± 1.26 days; p < 0.0001). There was no significant difference in flap loss or major complications among groups.
CONCLUSIONS
When used as part of a nonnarcotic postoperative pain regimen, transversus abdominis plane blocks performed with single injections of liposomal bupivacaine help facilitate early hospital discharge after abdominally based microsurgical breast reconstruction. A trend toward consistent discharge by postoperative day 2 was seen. This could result in significant cost savings for health care systems.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
术后使用麻醉性镇痛药控制疼痛所带来的副作用可能会延迟腹部显微外科乳房重建术后的恢复。作者评估了一种非麻醉性疼痛控制方案联合双侧腹横肌平面阻滞对促进早期出院的作用。
方法
对连续接受腹部游离皮瓣乳房重建的患者进行回顾性分析，这些患者使用或未使用术中腹横肌平面阻滞纳入非麻醉方案。在此期间，局部区域镇痛的使用从无（对照组）发展到布比卡因持续输注腹横肌平面及置管，再到使用脂质体布比卡因溶液进行单剂量腹横肌平面阻滞。报告了所有三组患者的人口统计学因素、住院时间、住院期间阿片类药物消耗量及并发症情况。
结果
共确定了128例连续患者（182个皮瓣）。脂质体布比卡因输注组40例患者（62个皮瓣），单剂量阻滞-置管组48例患者（66个皮瓣），对照组40例患者（54个皮瓣）。脂质体布比卡因输注组患者的住院时间明显短于单剂量阻滞-置管组（2.65±0.66天对3.52±0.92天；p<0.0001）和对照组（2.65±0.66天对4.05±1.26天；p<0.0001）。各组之间皮瓣丢失或严重并发症无显著差异。
结论
当作为非麻醉性术后疼痛方案的一部分使用时，单次注射脂质体布比卡因进行腹横肌平面阻滞有助于腹部显微外科乳房重建术后早期出院。术后第2天出现了持续一致出院的趋势。这可能会为医疗保健系统节省大量成本。
临床问题/证据水平：治疗性，III级。
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