Matulewicz Richard S, Patel Mehul, Jordan Brian J, Morano Jacqueline, Frainey Brendan, Bhanji Yasin, Bux Mahreen, Nader Antoun, Kundu Shilajit D, Meeks Joshua J
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Department of Anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Bladder Cancer. 2018 Apr 26;4(2):161-167. doi: 10.3233/BLC-170157.
Radical cystectomy (RC) is a morbid procedure with frequent complications that may benefit from implementation of an enhanced recovery after surgery (ERAS) protocol.
To examine the benefits of a multimodal analgesic plan that uses continuous transversus abdominis plane (TAP) blockade as part of an ERAS protocol after RC.
A retrospective comparison of consecutive patients undergoing RC over a 4-year period was conducted. Patients were designated as having surgery either before or after implementation of an ERAS protocol. A major component of the ERAS protocol was a multi-modal analgesia plan with TAP blockade. Patient demographics, comorbidities, operative details, and outcomes, including days to flatus, bowel movement (BM), narcotic usage, and length of stay (LOS) were compared.
In total, 171 patients were included: 100 pre-ERAS and 71 ERAS. There were no differences in age, smoking status, operative approach, or diversion type. The patients in the ERAS cohort were less likely to be male, had a higher median BMI, and more likely to have received neoadjuvant chemotherapy. Total and early postoperative narcotic use were lower in the ERAS cohort: 89 vs. 336 mg ( < 0.001) and 62 vs 203 mg ( = 0.001), respectively. The ERAS cohort had fewer days to flatus (3 vs. 4, < 0.001) and fewer days to bowel movement (4 vs. 5, < 0.001). Median LOS was shorter in the ERAS cohort (7 vs. 8.5d, = 0.001). There were no differences in complications or readmission rates between the two cohorts.
TAP blockade as part of an ERAS multi-modal pain plan is associated with low narcotic usage, and significant improvement in time to flatus, BM, and LOS compared to traditional post-RC pain management.
根治性膀胱切除术（RC）是一种创伤性较大的手术，并发症频发，实施术后加速康复（ERAS）方案可能会带来益处。
探讨在RC术后将连续腹横肌平面（TAP）阻滞作为ERAS方案一部分的多模式镇痛计划的益处。
对4年间连续接受RC手术的患者进行回顾性比较。患者被指定为在ERAS方案实施之前或之后接受手术。ERAS方案的一个主要组成部分是采用TAP阻滞的多模式镇痛计划。比较患者的人口统计学特征、合并症、手术细节和结局，包括排气天数、排便天数、麻醉药物使用情况和住院时间（LOS）。
总共纳入171例患者：100例在ERAS方案实施前，71例在ERAS方案实施后。在年龄、吸烟状况、手术方式或改道类型方面无差异。ERAS队列中的患者男性比例较低，中位BMI较高，且更有可能接受新辅助化疗。ERAS队列中术后总的和早期麻醉药物使用量较低：分别为89 vs. 336mg（<0.001）和62 vs 203mg（=0.001）。ERAS队列排气天数较少（3天 vs. 4天，<0.001），排便天数较少（4天 vs. 5天，<0.001）。ERAS队列的中位住院时间较短（7天 vs. 8.5天，=0.001）。两组之间在并发症或再入院率方面无差异。
与传统的RC术后疼痛管理相比，作为ERAS多模式疼痛计划一部分的TAP阻滞与低麻醉药物使用量以及排气时间、排便时间和住院时间的显著改善相关。
