From the Division of Plastic and Reconstructive Surgery, the Division of Public Health Sciences, and the Department of Anesthesiology, Washington University School of Medicine in St. Louis; and the Department of Anesthesiology, Wuhan No. 1 Hospital.
Plast Reconstr Surg. 2019 Jul;144(1):35-44. doi: 10.1097/PRS.0000000000005698.
Postoperative pain control after abdominally based autologous microvascular breast reconstruction is critical to functional recovery, patient satisfaction, and early discharge. The transversus abdominis plane block using 0.25% bupivacaine hydrochloride has been shown to be effective, but it is limited by a short duration of effect. Liposomal bupivacaine is a recently U.S. Food and Drug Administration-approved preparation of bupivacaine that can provide up to 72 hours of pain relief. The purpose of this randomized, controlled trial was to compare the analgesic efficacy of liposomal bupivacaine and conventional bupivacaine.
This study was a prospective, single-blind, randomized, controlled trial of 44 patients undergoing abdominally based autologous breast reconstruction between June of 2016 and February of 2018 performed by a single surgeon. Each patient was randomized to receive either 266 mg of liposomal bupivacaine or 75 mg of conventional bupivacaine to the transversus abdominis plane at the conclusion of the reconstruction procedure. All patients were managed postoperatively according to an enhanced recovery protocol.
In our study of 44 patients, 22 patients received a transversus abdominis plane block with conventional bupivacaine and 22 patients received liposomal bupivacaine. There were no significant differences with regard to any outcome measure. No differences were found in total opioid consumption (p = 0.98), Quality of Recovery-15 scores (p = 0.72), pain scores (p = 0.39), or length of stay (p = 0.20).
In the setting of a robust enhanced recovery after surgery protocol, liposomal bupivacaine does not confer advantages over conventional bupivacaine when used as single injections in transversus abdominis plane blocks after abdominally based microvascular breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
腹部自体微血管乳房重建术后的疼痛控制对功能恢复、患者满意度和早期出院至关重要。 布比卡因盐酸盐的腹横肌平面阻滞已被证明是有效的，但它的作用持续时间有限。 脂质体布比卡因是最近获得美国食品和药物管理局批准的布比卡因制剂，可提供长达 72 小时的止痛效果。 本随机对照试验的目的是比较脂质体布比卡因和传统布比卡因的镇痛效果。
本研究为前瞻性、单盲、随机、对照试验，纳入 2016 年 6 月至 2018 年 2 月期间由同一位外科医生进行的腹部自体乳房重建的 44 例患者。 每位患者随机接受 266 毫克脂质体布比卡因或 75 毫克传统布比卡因用于横腹平面阻滞。 所有患者均根据强化康复方案进行术后管理。
在我们的 44 例患者研究中，22 例患者接受了传统布比卡因的横腹平面阻滞，22 例患者接受了脂质体布比卡因。 在任何结果测量方面均无显着差异。 总阿片类药物消耗量（p = 0.98）、恢复质量-15 评分（p = 0.72）、疼痛评分（p = 0.39）或住院时间（p = 0.20）均无差异。
在强有力的术后强化康复方案中，在腹部基于微血管乳房重建后使用单次注射时，脂质体布比卡因与传统布比卡因相比，在横腹平面阻滞中没有优势。
临床问题/证据水平：治疗，II 级。
