From the Division of Plastic and Reconstructive Surgery, Baylor Scott & White Medical Center; Baylor Scott & White Research Institute; and Texas A&M College of Medicine.
Plast Reconstr Surg. 2022 Sep 1;150(3):506e-515e. doi: 10.1097/PRS.0000000000009398. Epub 2022 Jun 24.
Transversus abdominis plane blocks can improve pain control and decrease opioid use within an enhanced recovery after surgery (ERAS) protocol in patients undergoing abdominally based autologous breast reconstruction. The authors have transitioned to using a local analgesic cocktail for transversus abdominis plane blocks. The purpose of this study was to compare postoperative opioid use in patients who received the blocks.
Patients who underwent abdominally based autologous breast reconstruction between November of 2015 and December of 2019 were retrospectively reviewed. The study group received bupivacaine, ketorolac, dexmedetomidine, and dexamethasone; the control group received liposomal bupivacaine with or without bupivacaine, ketorolac, or dexmedetomidine, as a transversus abdominis plane block. The primary outcome of interest was postoperative opioid use and pain scores.
One hundred four women met inclusion criteria: 36 in group A (before ERAS, before transversus abdominis plane block), 38 in group B (ERAS, transversus abdominis plane block with liposomal bupivacaine), and 30 in group C (ERAS, transversus abdominis plane block with local anesthetic cocktail). Total daily oral morphine equivalent consumption (group A, 633; group B, 240; group C, 135; p < 0.0001) and average daily oral morphine equivalent consumption (group A, 137; group B, 56; group C, 29; p < 0.0001) were significantly less for group C in the inpatient phase. Patients in group C were prescribed significantly fewer outpatient oral morphine equivalents (group A, 79; group B, 74; group C, 52; p = 0.01).
Transversus abdominis plane blocks are a significant component of an ERAS protocol for abdominally based breast reconstruction. Liposomal bupivacaine is a popular option for transversus abdominis plane blocks. The authors' results demonstrate that a local anesthetic cocktail, composed of economical and readily available medications, can provide excellent patient pain control and decrease postoperative opioid use.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在加速康复外科（ERAS）方案中，腹横肌平面阻滞（TAPB）可改善疼痛控制并减少阿片类药物的使用，用于接受腹部自体乳房重建的患者。作者已过渡到使用局部镇痛鸡尾酒进行 TAPB。本研究的目的是比较接受阻滞的患者术后阿片类药物的使用情况。
回顾性分析 2015 年 11 月至 2019 年 12 月期间接受腹部自体乳房重建的患者。研究组接受布比卡因、酮咯酸、右美托咪定和地塞米松；对照组接受脂质体布比卡因加或不加布比卡因、酮咯酸或右美托咪定的 TAPB。主要观察指标为术后阿片类药物的使用和疼痛评分。
共有 104 名女性符合纳入标准：A 组 36 例（ERAS 前，TAPB 前），B 组 38 例（ERAS，含脂质体布比卡因的 TAPB），C 组 30 例（ERAS，含局部麻醉鸡尾酒的 TAPB）。总日口服吗啡等效消耗量（A 组 633；B 组 240；C 组 135；p<0.0001）和平均日口服吗啡等效消耗量（A 组 137；B 组 56；C 组 29；p<0.0001）在住院期间 C 组显著较低。C 组患者开出的门诊口服吗啡等效物明显较少（A 组 79；B 组 74；C 组 52；p=0.01）。
TAPB 是腹部乳房重建中 ERAS 方案的重要组成部分。脂质体布比卡因是 TAPB 的常用选择。作者的结果表明，由经济且易于获得的药物组成的局部麻醉鸡尾酒可提供出色的患者疼痛控制并减少术后阿片类药物的使用。
临床问题/证据水平：治疗性，III 级。
