Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
Tech Coloproctol. 2020 Nov;24(11):1179-1187. doi: 10.1007/s10151-020-02311-9. Epub 2020 Jul 28.
The optimal opioid-sparing analgesic regimen following laparoscopic colorectal surgery (LCS) remains uncertain. We sought to determine the efficacy of low-dose bupivacaine infusion via surgeon-inserted modified continuous transversus abdominis plane (mcTAP) catheters after LCS.
A parallel-group, placebo-controlled, randomized single-centre trial was conducted between April 2017 and February 2018. Block-of-four randomization and allocation concealment by sequentially-numbered, opaque sealed envelopes were used. Patients, surgeons and assessors were blinded. Fifty-two patients were randomized to receive either 0.2% bupivacaine or saline through mcTAP catheters. A 5 ml bolus followed by a 72 h infusion at 2 ml/h was started, with patient-controlled fentanyl analgesia and oral paracetamol given on demand. Primary outcomes were fentanyl consumptions in the first 24 h, second 24 h, and third 24 h following surgery. Secondary outcomes were pain numeric rating scores, recovery outcomes and complications.
Twenty-five patients in the bupivacaine group and 26 in the control group were analysed. Patients in the bupivacaine group required significantly less fentanyl overall (106.1 vs 484.5 mcg, p < 0.001) and at all time points (first 24 h: 61.0 vs 324.3 mcg, p < 0.001; second 24 h: 36.3 vs 119.0 mcg, p = 0.033; third 24 h: 8.8 vs 41.2, p = 0.030) when compared to placebo. Significantly lower pain scores at rest at 6 h (2.32 vs 4.0, p = 0.002), and 12 h (1.80 vs 3.08, p = 0.011) and on coughing at 6 h (4.56 vs 5.84, p = 0.019), 12 h (3.76 vs 4.96, p = 0.009), and 24 h (3.44 vs 4.24, p = 0.049) as well as significantly lower opioid-related complications such as nausea or vomiting (9 (36%) vs 1 (4%), p = 0.005) were observed in the bupivacaine group. There were no major block-related complications, and recovery outcomes were similar in both groups.
McTAP block reduces postoperative fentanyl consumption and pain scores after LCS, highlighting its role as a safe and useful opioid-sparing analgesia.
TCTR20150831001 (Thai Clinical Trials Registry). Full trial protocol can be assessed at https://www.clinicaltrials.in.th/ .
腹腔镜结直肠手术后（LCS）最佳的阿片类药物节约型镇痛方案仍不确定。我们旨在确定通过外科医生插入改良的连续腹横肌平面（mcTAP）导管给予小剂量布比卡因输注在 LCS 后的疗效。
2017 年 4 月至 2018 年 2 月进行了一项平行组、安慰剂对照、随机单中心试验。采用四部分随机分组和顺序编号、不透明密封信封进行的分组隐藏。患者、外科医生和评估者均处于盲态。52 名患者随机分为接受布比卡因 0.2%或生理盐水通过 mcTAP 导管。以 5 ml 推注，随后以 2 ml/h 的速度输注 72 小时，同时给予患者自控芬太尼镇痛和按需口服扑热息痛。主要结局是术后 24 小时、48 小时和 72 小时的芬太尼消耗量。次要结局是疼痛数字评分、恢复结局和并发症。
布比卡因组 25 例患者和对照组 26 例患者被纳入分析。布比卡因组患者总体上需要的芬太尼明显减少（106.1 对 484.5 mcg，p < 0.001），并且在所有时间点（第 1 天：61.0 对 324.3 mcg，p < 0.001；第 2 天：36.3 对 119.0 mcg，p = 0.033；第 3 天：8.8 对 41.2，p = 0.030）与安慰剂相比。与安慰剂相比，布比卡因组患者在 6 小时（2.32 对 4.0，p = 0.002）和 12 小时（1.80 对 3.08，p = 0.011）时静息时的疼痛评分显著降低，6 小时（4.56 对 5.84，p = 0.019）、12 小时（3.76 对 4.96，p = 0.009）和 24 小时（3.44 对 4.24，p = 0.049）时咳嗽时的疼痛评分也显著降低，以及阿片类药物相关并发症如恶心或呕吐（9（36%）对 1（4%），p = 0.005）明显减少。在布比卡因组中未观察到主要阻滞相关并发症，并且两组的恢复结局相似。
mcTAP 阻滞可减少 LCS 后芬太尼的消耗和疼痛评分，突出了其作为一种安全且有用的阿片类药物节约型镇痛的作用。
TCTR20150831001（泰国临床试验注册处）。完整的试验方案可在 https://www.clinicaltrials.in.th/ 评估。
