Centro de Excelencia para el Estudio y Tratamiento de la Obesidad, Valladolid, Spain.
Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Madrid, Spain.
Obes Surg. 2018 Nov;28(11):3374-3379. doi: 10.1007/s11695-018-3376-8.
Despite the ultrasound guidance of transversus abdominis plane (TAP) blocks has allowed greater precision of needle placement in the desired tissue plane, visualization of the abdominal wall muscles can be hindered by morbid obesity and could lead to failed regional anesthesia. The aim of this study was to assess the feasibility and effect of laparoscopic-guided TAP block in patients undergoing Roux-en-Y gastric bypass and to compare it with port-site infiltration.
A prospective randomized clinical trial was performed. Patients were randomized into two groups: patients undergoing laparoscopic-guided TAP (TAP-lap) and patients undergoing port-site infiltration (PSI). Pain quantification as measured by visual analogic scale (VAS) and morphine needs during the first 24 h were evaluated.
One hundred and forty patients were included, 70 in each group. The mean operation time was 83.3 + 15.6 min in TAP-lap and 80.5 + 14.4 min in PSI (NS). The mean postoperative pain, as measured by VAS, 24 h after surgery was 16.8 + 11.2 mm in PSI and 10 + 8.1 mm in TAP-lap (p = 0.001). Morphine rescues were necessary in 13.2% in PSI and 2.9% in TAP-lap (p = 0.026). The mean hospital stay was 2.1 + 1.2 days in TAP-lap and 2.9 + 1.3 days in PSI (p = 0.019). Hospital discharge during the first 48 h after surgery was possible in 52.9% of the patients in PSI and 71% in TAP-lap (OR 4.75; 95% CI 2.1-10.8; p = 0.029).
Laparoscopic-guided TAP block can reduce postoperative pain, opioid needs, and hospital stay, when compared with port-site infiltration with the same anesthetic drug, without increasing operation time.
ClinicalTrials.gov Identifier: NCT03203070.
尽管超声引导下的腹横肌平面（TAP）阻滞可以更精确地将针头放置在所需的组织平面中，但病态肥胖可能会阻碍腹壁肌肉的可视化，并导致区域麻醉失败。本研究旨在评估腹腔镜引导下 TAP 阻滞在 Roux-en-Y 胃旁路手术患者中的可行性和效果，并与切口部位浸润进行比较。
进行了一项前瞻性随机临床试验。患者被随机分为两组：接受腹腔镜引导下 TAP（TAP-lap）的患者和接受切口部位浸润（PSI）的患者。通过视觉模拟评分（VAS）评估术后 24 小时内的疼痛程度和吗啡需求。
共纳入 140 例患者，每组 70 例。TAP-lap 组的平均手术时间为 83.3±15.6 分钟，PSI 组为 80.5±14.4 分钟（NS）。术后 24 小时，VAS 测量的平均术后疼痛在 PSI 组为 16.8±11.2mm，在 TAP-lap 组为 10±8.1mm（p=0.001）。PSI 组需要吗啡解救的患者比例为 13.2%，TAP-lap 组为 2.9%（p=0.026）。TAP-lap 组的平均住院时间为 2.1±1.2 天，PSI 组为 2.9±1.3 天（p=0.019）。PSI 组术后 48 小时内出院的患者比例为 52.9%，TAP-lap 组为 71%（OR 4.75；95%CI 2.1-10.8；p=0.029）。
与使用相同麻醉药物的切口部位浸润相比，腹腔镜引导下 TAP 阻滞可减轻术后疼痛、阿片类药物需求和住院时间，而不会增加手术时间。
ClinicalTrials.gov 标识符：NCT03203070。
