采用术后加速康复和术中腹横肌平面阻滞可减少大型开放性腹疝修补术中阿片类药物的使用并缩短住院时间。
Adoption of enhanced recovery after surgery and intraoperative transverse abdominis plane block decreases opioid use and length of stay in very large open ventral hernia repairs.
作者信息
Shao Jenny M, Deerenberg Eva B, Prasad Tanu, Dunphy Colleen, Colavita Paul D, Augenstein Vedra A, Heniford B Todd
机构信息
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA.
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA.
出版信息
Am J Surg. 2021 Oct;222(4):806-812. doi: 10.1016/j.amjsurg.2021.02.025. Epub 2021 Feb 26.
BACKGROUND
The effect of an enhanced recovery after surgery (ERAS) pathway including liposomal bupivacaine transversus abdominus plane (TAP)-blocks for abdominal wall reconstruction (AWR) on opioids use is not clear.
METHODS
A prospective, tertiary hernia center database of patients undergoing AWR before and after ERAS and operative TAP-blocks was matched in large ventral hernias.
RESULTS
In 106 patients, non-TAP-block and TAP-block groups were comparable in mean BMI (p = 0.694), hernia defect size (p = 0.424), components separation (p = 0.610), complete fascial closure (p = 1.0), and panniculectomy (p = 1.0). The total morphine milligram equivalents (MME) used during hospitalization was reduced by 3-fold in the TAP-block group (p < 0.001), and opioid usage decreased by 35%-71% during days 1-5. Length of stay (LOS) was shorter in the TAP-block group by average of 1 day (p = 0.011).
CONCLUSION
ERAS and TAP-block in AWR leads to a decrease in mean opioid usage by 65% and decreased LOS by an average of 1 day.
背景
包括脂质体布比卡因腹横肌平面（TAP）阻滞在内的术后加速康复（ERAS）方案用于腹壁重建（AWR）对阿片类药物使用的影响尚不清楚。
方法
在一个大型腹疝患者中，对ERAS和手术TAP阻滞前后接受AWR的患者的前瞻性三级疝中心数据库进行匹配。
结果
106例患者中，非TAP阻滞组和TAP阻滞组在平均体重指数（p = 0.694）、疝缺损大小（p = 0.424）、成分分离（p = 0.610）、筋膜完全闭合（p = 1.0）和腹壁成形术（p = 1.0）方面具有可比性。TAP阻滞组住院期间使用的吗啡总毫克当量（MME）减少了3倍（p < 0.001），在第1 - 5天阿片类药物使用量减少了35% - 71%。TAP阻滞组的住院时间（LOS）平均缩短1天（p = 0.011）。
结论
AWR中的ERAS和TAP阻滞导致平均阿片类药物使用量减少65%，住院时间平均缩短1天。
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