Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA.
Surg Endosc. 2020 May;34(5):2197-2203. doi: 10.1007/s00464-019-07008-1. Epub 2019 Jul 29.
The morbidly obese (MO) patient presents a unique challenge to pain control in the postoperative period due to associated comorbidities and the amplified impact of opiates. In order to reduce potential complications associated with narcotic use in the MO patient, multimodal analgesia has been advocated. In this study, we examined the effect of laparoscopic-guided transversus abdominis plane block (LG TAP) for further optimizing multimodal pain control.
This is a retrospective analysis of a prospectively collected database of 140 consecutive patients undergoing LSG without TAP block (pre-TAP group) compared to 131 patients undergoing LSG with LGTAP (TAP group). All operations were performed laparoscopically utilizing uniform clinical pathways. Baseline characteristics for both groups were comparable. Both groups received standardized anesthesia. Outcomes included time to postoperative ambulation, pain scores, PCA volume, length of hospital stay, utilization of oral opiate medications, and return to activity (RTA).
Pre-TAP versus TAP groups were comparable, mean age 42 years (p = 0.99), women 81.4% versus 87.8% (p = 0.148), mean BMI (kg/m) 46 versus 45 (p = 0.394). Most patients ambulated within 2 h after arrival to the floor (87.9% vs. 76.3%, p = 0.013). On postoperative day (POD) 1, mean reported pain score (0-10) was 4.50 vs. 5.06 (p = 0.063) and a mean PCA morphine used for 24 h was 26.3 mL versus 26 mL, p = 0.35. Mean days of postoperative opiate medication were 2.19 versus 1.24 (p < 0.001). Return to activity was 2.81 versus 2.08 days (p < 0.001). When controlled for age, BMI, OR time, PCA volume used, and average pain score, TAP block was an independent predictor of earlier return to activities (p < 0.001).
LGTAP block following LSG is an additional valuable modality of pain control in the perioperative period. Our study shows that TAP block is associated with an earlier RTA and decreased opiate use in patients undergoing LSG.
病态肥胖（MO）患者由于合并症和阿片类药物影响放大，在术后期间的疼痛控制方面提出了独特的挑战。为了减少 MO 患者使用麻醉药物相关的潜在并发症，提倡使用多模式镇痛。在这项研究中，我们检查了腹腔镜引导下腹横肌平面阻滞（LG TAP）对进一步优化多模式疼痛控制的效果。
这是一项回顾性分析，纳入了 140 例连续接受腹腔镜袖状胃切除术（LSG）但未接受 TAP 阻滞（术前 TAP 组）的患者，以及 131 例接受 LG TAP 的患者（TAP 组）。所有手术均采用腹腔镜，使用统一的临床路径进行。两组的基线特征相似。两组均接受标准化麻醉。结果包括术后活动时间、疼痛评分、PCA 容量、住院时间、口服阿片类药物的使用情况以及恢复活动（RTA）。
术前 TAP 组与 TAP 组相比，平均年龄为 42 岁（p=0.99），女性占 81.4%（p=0.148），平均 BMI（kg/m）为 46（p=0.394）。大多数患者在到达病房后 2 小时内即可行走（87.9% vs. 76.3%，p=0.013）。在术后第 1 天，报告的平均疼痛评分（0-10 分）为 4.50 分 vs. 5.06 分（p=0.063），24 小时 PCA 吗啡用量为 26.3 mL vs. 26 mL，p=0.35。术后使用阿片类药物的平均天数为 2.19 天 vs. 1.24 天（p<0.001）。恢复活动的平均时间为 2.81 天 vs. 2.08 天（p<0.001）。当控制年龄、BMI、手术时间、PCA 容量和平均疼痛评分时，TAP 阻滞是患者术后早期恢复活动的独立预测因素（p<0.001）。
LSG 后 LG TAP 阻滞是围手术期疼痛控制的另一种有价值的方式。我们的研究表明，TAP 阻滞与 RTA 更早和阿片类药物使用减少相关，接受 LSG 的患者获益。
