Aamir Muhammad Awais, Sahebally Shaheel Mohammad, Heneghan Helen
Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Surgery, St Vincent's University Hospital, Dublin, Ireland.
Obes Surg. 2021 Jan;31(1):133-142. doi: 10.1007/s11695-020-04898-2. Epub 2020 Aug 10.
Effective postoperative analgesia is paramount in patients undergoing bariatric surgery, given their increased predisposition to narcotic-induced respiratory depression. Transversus abdominis plane (TAP) block has shown promise in the enhanced recovery pathway for several abdominal procedures. We performed a systematic review and meta-analysis to compare the effectiveness of TAP block in laparoscopic bariatric surgery.
PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until June 2020. All randomized trials that compared TAP blocks versus none in laparoscopic bariatric procedures were included. The primary outcome was narcotic consumption at 24 h postoperatively, whilst secondary outcomes included postoperative pain scores at 24 h, time to ambulation, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates.
Seven randomized controlled trials were included, capturing 617 patients. There was high statistical heterogeneity across studies. On random effects analysis, there were no significant differences in narcotic consumption (MD -12.63 mg, 95% CI = -31.67 to 6.41, p = 0.19), pain scores (MD -0.71, 95% CI = -1.93 to 0.50, p = 0.25) or complications (RD = -0.00, 95% CI = -0.03 to 0.03, p = 0.87) between TAP and no TAP groups. However, TAP was associated with significantly less time to ambulation (MD -2.22 h, 95% CI = -3.89 to -0.56, p = 0.009) and PONV (OR = 0.13, 95% CI = 0.05 to 0.35, p < 0.0001).
TAP in laparoscopic bariatric surgery is associated with significantly less PONV and time to ambulation, but similar complication rates, narcotic usage and postoperative pain at 24 h compared to no TAP.
鉴于肥胖症手术患者更容易出现麻醉引起的呼吸抑制，有效的术后镇痛至关重要。腹横肌平面（TAP）阻滞在多种腹部手术的加速康复路径中已显示出前景。我们进行了一项系统评价和荟萃分析，以比较TAP阻滞在腹腔镜肥胖症手术中的有效性。
检索PubMed、EMBASE和Cochrane数据库，查找从数据库建立至2020年6月的相关文章。纳入所有比较腹腔镜肥胖症手术中TAP阻滞与不进行TAP阻滞的随机试验。主要结局是术后24小时的麻醉药物消耗量，次要结局包括术后24小时的疼痛评分、下床活动时间、术后恶心呕吐（PONV）和并发症发生率。采用随机效应模型计算合并效应量估计值。
纳入七项随机对照试验，共617例患者。各研究间存在高度统计学异质性。随机效应分析显示，TAP阻滞组与非TAP阻滞组在麻醉药物消耗量（MD -12.63mg，95%CI = -31.67至6.41，p = 0.19）、疼痛评分（MD -0.71，95%CI = -1.93至0.50，p = 0.25）或并发症（RD = -0.00，95%CI = -0.03至0.03，p = 0.87）方面无显著差异。然而，TAP阻滞与显著缩短的下床活动时间（MD -2.22小时，95%CI = -3.89至-0.56，p = 0.009）和PONV发生率（OR = 0.13，95%CI = 0.05至0.35，p < 0.0001）相关。
与不进行TAP阻滞相比，腹腔镜肥胖症手术中TAP阻滞与显著降低的PONV发生率和缩短的下床活动时间相关，但24小时时的并发症发生率、麻醉药物使用量和术后疼痛相似。
