Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Surg Endosc. 2022 Oct;36(10):7204-7209. doi: 10.1007/s00464-022-09076-2. Epub 2022 Feb 2.
Post-operative pain relief after abdominal operations is critical for patient satisfaction and rapid recovery. Narcotics have been a traditional part of postoperative analgesia, with transversus abdominis plane (TAP) block introduced recently. The aim of this study is to assess the efficacy of laparoscopic TAP block on postoperative pain control in patients undergoing minimally invasive adrenalectomy.
This was an institutional review board-approved retrospective study. Parameters related to postoperative pain control were compared between patients who underwent robotic transabdominal lateral adrenalectomy with (after December 2018) or without laparoscopic TAP block (control group) (before December 2018) by one surgeon. Statistics were performed using Mann Whitney U and Chi-square tests.
There were 86 patients in the TAP and 83 patients in the control group. Groups were similar regarding demographic and clinical parameters. Despite the availability of intravenous acetaminophen to a higher percentage of patients in the control (31.3%) versus the TAP group (8.1%), 0-24 h lowest postoperative pain scores were significantly lower in the TAP group (P < 0.0001). In TAP versus control group, percentage of patients requiring narcotics and amount of narcotics used was lower (P = 0.04 vs P = 0.0004, respectively). Mainly due to less pain-related over-stay, percentage of patients requiring more than a day of hospital stay was less in the TAP (12%) versus control group (18%) (P = 0.01).
To our knowledge, the utility of TAP block in patients undergoing minimally invasive adrenalectomy has not been reported in the past. This study shows that there may be benefits of laparoscopic TAP block in reducing post-operative narcotic usage while improving pain control in these patients.
腹部手术后的止痛对于患者满意度和快速康复至关重要。麻醉剂一直是术后镇痛的传统方法，最近引入了腹横肌平面（TAP）阻滞。本研究旨在评估腹腔镜 TAP 阻滞在微创肾上腺切除术患者术后疼痛控制中的疗效。
这是一项机构审查委员会批准的回顾性研究。通过一名外科医生比较了接受机器人经腹侧肾上腺切除术的患者（2018 年 12 月后）或未接受腹腔镜 TAP 阻滞（对照组）（2018 年 12 月前）的患者与术后疼痛控制相关的参数。使用 Mann-Whitney U 和卡方检验进行统计学分析。
TAP 组有 86 例患者，对照组有 83 例患者。两组在人口统计学和临床参数方面相似。尽管对照组（31.3%）比 TAP 组（8.1%）有更多的患者接受静脉注射对乙酰氨基酚，但 TAP 组术后 0-24 小时最低疼痛评分明显较低（P<0.0001）。与对照组相比，TAP 组需要使用麻醉药物的患者比例和使用的麻醉药物量较低（P=0.04 和 P=0.0004）。主要由于疼痛相关的住院时间延长较少，TAP 组（12%）比对照组（18%）需要住院超过一天的患者比例较低（P=0.01）。
据我们所知，过去尚未报道 TAP 阻滞在微创肾上腺切除术患者中的应用。本研究表明，腹腔镜 TAP 阻滞可能有助于减少术后麻醉药物的使用，同时改善这些患者的疼痛控制。
