Singh Preet Mohinder, Borle Anuradha, Makkar Jeetinder Kaur, Trisha Aanjan, Sinha Aashish
Department of Anesthesia, Pain Medicine & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Saudi J Anaesth. 2018 Apr-Jun;12(2):261-271. doi: 10.4103/sja.SJA_598_17.
Patients undergoing renal transplant (RT) have altered drug/opioid pharmacokinetics. Transversus abdominis plane (TAP) block in renal transplant recipients has been recently evaluated for analgesic and opioid-sparing potential by many trials.
The studies comparing TAP-block to conventional analgesic regimens for RT were searched. Comparisons were made for total opioids consumed (as morphine-equivalents) during the first postoperative 24-h (primary objective), intraoperative, and immediate-postoperative period. Pain scores and postoperative nausea-vomiting (PONV) were also evaluated. Trial sequential analysis (TSA) was used to quantify the strength of analysis.
Ten-trials with 258 and 237 patients in control and TAP-block group, respectively, were included. TAP-block decreased the 24-h (reported in 9-trials) opioid consumption by 14.61 ± 4.34 mg (reduction by 42.7%, random-effects, < 0.001, = 97.82%). Sample size of the present analysis (472) was well past the required "information-size" variable (396) as per the TSA for a power of 85%. Intraoperative opioid consumption also decreased by 2.06 ± 0.63 mg (reduction of 27.8%) (random effects, < 0.001, = 98.84%). Pain scores with TAP-block were significantly lower in both early and delayed postoperative phase. Odds ratio for PONV without TAP block was 1.99 ± 1.05 (Fixed-effects, = 0.04, = 0%). Publication bias was likely (Egger's test, X-intercept=7.89, < 0.05).
TAP-block significantly lowers the intraoperative and cumulative postoperative 24-h opioid consumption in RT recipients. Persistent and better pain control is achieved when TAP-Block is used. Benefits of TAP block extend beyond the analgesic actions alone as it also decreases the 24-h incidence of postoperative nausea vomiting as well. The technique of the block needs standardization for RT recipients.
接受肾移植（RT）的患者药物/阿片类药物的药代动力学发生改变。近期许多试验对肾移植受者的腹横肌平面（TAP）阻滞的镇痛及阿片类药物节省潜力进行了评估。
检索比较TAP阻滞与RT传统镇痛方案的研究。对术后首个24小时（主要目标）、术中及术后即刻期间消耗的总阿片类药物（以吗啡当量计）进行比较。还评估了疼痛评分及术后恶心呕吐（PONV）情况。采用试验序贯分析（TSA）量化分析的强度。
纳入了10项试验，对照组和TAP阻滞组分别有258例和237例患者。TAP阻滞使24小时（9项试验报告）阿片类药物消耗量减少14.61±4.34毫克（减少42.7%，随机效应，<0.001，I² = 97.82%）。根据TSA，对于85%的检验效能，本分析的样本量（472）远超过所需的“信息量”变量（396）。术中阿片类药物消耗量也减少了2.06±0.63毫克（减少27.8%）（随机效应，<0.001，I² = 98.84%）。TAP阻滞在术后早期和延迟期的疼痛评分均显著更低。未进行TAP阻滞时PONV的优势比为1.99±1.05（固定效应，P = 0.04，I² = 0%）。可能存在发表偏倚（Egger检验，X轴截距 = 7.89，P<0.05）。
TAP阻滞显著降低肾移植受者术中及术后24小时累积阿片类药物消耗量。使用TAP阻滞可实现持续且更好的疼痛控制。TAP阻滞的益处不仅限于镇痛作用，因为它还降低了术后恶心呕吐的24小时发生率。该阻滞技术需要针对肾移植受者进行标准化。
