Department of Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, MI, 48202, Detroit, USA.
Department of Anesthesiology, Henry Ford Hospital, 2799 W. Grand Blvd, 48202, Detroit, MI, USA.
BMC Anesthesiol. 2021 Apr 12;21(1):114. doi: 10.1186/s12871-021-01333-6.
Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs. postoperative plain 0.25 % bupivacaine TAP block on postoperative opioid use after colorectal surgery.
A retrospective cohort study comparing postoperative opioid use in patients who received preoperative (n = 240) vs. postoperative (n = 22) plain 0.25 % bupivacaine TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The primary outcome of the study was postoperative opioid use. Secondary outcomes included operative details, length of stay, reoperation, and readmission rates.
Patients who received postoperative plain 0.25 % bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1 % vs. 83.3 %; p = 0.012) and opioid medications on discharge (6.4 % vs. 16.9 %; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs. 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral opioid use, and length of stay.
Plain 0.25 % bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge opioid medications. The overall hospital length of stay was not affected by the timing of TAP block. Because of the limited sample size in this study, conclusions cannot be generalized, and more research will be required.
强化康复方案通过包括腹横肌平面（TAP）阻滞的多模式方法来优化疼痛控制。本研究的目的是评估术前与术后单纯 0.25%布比卡因 TAP 阻滞对结直肠手术后阿片类药物使用的影响。
这是一项回顾性队列研究，比较了接受术前（n=240）和术后（n=22）单纯 0.25%布比卡因 TAP 阻滞的患者术后阿片类药物使用情况。该研究在一家单一的三级护理机构进行，纳入了 2018 年 8 月至 2020 年 1 月期间接受结直肠切除术的患者。该研究的主要结局是术后阿片类药物的使用。次要结局包括手术细节、住院时间、再次手术和再入院率。
与接受术前 TAP 的患者相比，接受术后单纯 0.25%布比卡因 TAP 阻滞的患者术后更不太需要使用患者自控镇痛（PCA）（59.1% vs. 83.3%；p=0.012）和出院时的阿片类药物（6.4% vs. 16.9%；p=0.004）。需要时，术后组开具的阿片类药物剂量明显较小（84.5 与 32.0mg，p=0.047）。术后 PCA 使用时间、口服阿片类药物使用量和住院时间无显著差异。
术后给予单纯 0.25%布比卡因 TAP 阻滞与术后 PCA 和出院阿片类药物的需求明显降低相关。TAP 阻滞的时机并未影响总体住院时间。由于本研究样本量有限，因此无法推广结论，还需要进一步研究。
