12281University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND, USA.
Department of Graduate Medical Education-24195Sanford Health, Fargo, ND, USA.
Am Surg. 2022 Sep;88(9):2094-2099. doi: 10.1177/00031348221087923. Epub 2022 Apr 28.
The ultrasound-guided transversus abdominis plane (TAP) block can be time-consuming, costly, and technically challenging in the bariatric patient population. Laparoscopic-assisted TAP (L-TAP) block was developed and has been shown to be non-inferior to ultrasound-guided blocks. Postoperative pain can be significant, and pain control in the morbidly obese patients can be challenging. This study's aim was to compare L-TAP block to traditional port site infiltration in terms of postoperative opioid requirement for morbidly obese patients after laparoscopic Roux-en-Y gastric bypass (RYGB) surgery.
A retrospective chart review was performed from February 2019 through February 2020. Two study groups: L-TAP block and port site infiltration. Outcomes examined the amount of opioid used at different time segments relative to the operation. All intravenous (IV) and oral opioids used were converted into IV morphine milligram equivalents (MME) for standardization.
150 patients were included. The patient characteristics were not statistically significant between the two groups. Post-operative opioid use trended lower in the L-TAP block group in all time segments. A significant difference was detected in IV opioid use during post-operative day 0 with the mean MME for the L-TAP block group being 1.1±3.8 and port site infiltration group being 2.8±4.5 (P = .02)
The L-TAP block more effectively reduces postoperative opioid use in comparison to port site infiltration in laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. Based on these findings, as well as the efficiency and cost-effectiveness of L-TAP blocks, its routine use in laparoscopy should be considered.
在肥胖患者人群中，超声引导下腹横肌平面（TAP）阻滞可能既耗时又昂贵，并且技术上具有挑战性。腹腔镜辅助 TAP（L-TAP）阻滞已经被开发出来，并已被证明不劣于超声引导下阻滞。术后疼痛可能很明显，肥胖患者的疼痛控制可能具有挑战性。本研究的目的是比较 L-TAP 阻滞与传统的端口部位浸润在腹腔镜 Roux-en-Y 胃旁路（RYGB）手术后肥胖患者术后阿片类药物需求方面的差异。
回顾性图表审查于 2019 年 2 月至 2020 年 2 月进行。两个研究组：L-TAP 阻滞和端口部位浸润。结果检查了与手术相关的不同时间段内使用的阿片类药物的数量。所有静脉（IV）和口服阿片类药物均转换为 IV 吗啡毫克当量（MME）进行标准化。
共纳入 150 例患者。两组患者的特征在统计学上无显著差异。在所有时间段内，L-TAP 阻滞组的术后阿片类药物使用量呈下降趋势。在术后第 0 天，L-TAP 阻滞组的 IV 阿片类药物使用量存在显著差异，其平均 MME 为 1.1±3.8，而端口部位浸润组为 2.8±4.5（P=.02）。
与腹腔镜 Roux-en-Y 胃旁路（RYGB）手术中的端口部位浸润相比，L-TAP 阻滞更有效地减少了术后阿片类药物的使用。基于这些发现，以及 L-TAP 阻滞的效率和成本效益，应考虑在腹腔镜手术中常规使用。
