Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130, United States of America.
Willis Knighton Health System, 2508 Bert Kouns Industrial Loop, Suite 300, Shreveport, LA 71118, United States of America.
Gynecol Oncol. 2022 Sep;166(3):432-437. doi: 10.1016/j.ygyno.2022.06.006. Epub 2022 Jul 9.
The purpose of this study was to determine if laparoscopically guided transversus abdominis plane block (Lap-Tap) with liposomal bupivacaine provides superior postoperative pain control when compared to ultrasound-guided block (US-Tap) with liposomal bupivacaine at the time of robotic surgery for gynecology oncology patients.
This was a prospective randomized controlled trial assigning patients to one of two cohorts: Cohort 1 consisted of US-Tap administered before the procedure using liposomal bupivacaine, Cohort 2 consisted of Lap-Tap administration with laparoscopic visualization using the medication above. Primary outcomes were pain scores and total opioid use in Oral Morphine Equivalents (OME) during the first 72 h after surgery. Secondary outcomes were postoperative pain satisfaction and oral narcotic requirements.
There was a significant increase in oral narcotic use in the first 24 h in the US-Tap cohort compared to the Lap-Tap cohort: Lap-Tap mean = 6.73 ± 8.22 OME versus US-Tap mean = 12.69 ± 12.94 p = 0.018 OME. The increase was equivalent to one additional Hydrocodone-Acetaminophen 7.5 mg/325 mg in the first 24 h after surgery. However, total oral narcotic use over the first 72 h was not significantly different between the two cohorts: Lap-Tap mean = 21.73 ± 19.83 OME, US-Tap mean = 32.50 ± 29.47, p = 0.062 OME. In addition, there was no significant difference in satisfaction or pain scores between the US-Tap and Lap-Tap groups at 24, 48, or 72-hours.
Lap-Taps are comparable to US-Tap for postoperative analgesia during the first 72-h after surgery when performing robotic-assisted gynecologic oncology surgery.
本研究旨在确定与超声引导下阻滞（US-Tap）相比，腹腔镜引导下腹横肌平面阻滞（Lap-Tap）联合脂质体布比卡因在妇科肿瘤机器人手术时能否提供更好的术后疼痛控制。
这是一项前瞻性随机对照试验，将患者分为两组：第 1 组（Cohort 1）接受 US-Tap，术前使用脂质体布比卡因；第 2 组（Cohort 2）接受 Lap-Tap，使用腹腔镜可视化技术。主要结局是术后 72 小时内的疼痛评分和口服吗啡等效物（Oral Morphine Equivalents，OME）的总阿片类药物使用量。次要结局是术后疼痛满意度和口服阿片类药物的需求。
与 Lap-Tap 组相比，US-Tap 组在术后 24 小时内口服阿片类药物的使用量显著增加：Lap-Tap 组平均 = 6.73 ± 8.22 OME，US-Tap 组平均 = 12.69 ± 12.94 p = 0.018 OME。这相当于术后 24 小时内额外使用一片氢可酮-对乙酰氨基酚 7.5 mg/325 mg。然而，两组在术后 72 小时内的总口服阿片类药物使用量无显著差异：Lap-Tap 组平均 = 21.73 ± 19.83 OME，US-Tap 组平均 = 32.50 ± 29.47，p = 0.062 OME。此外，两组在术后 24、48 和 72 小时的满意度或疼痛评分均无显著差异。
在进行机器人辅助妇科肿瘤手术时，Lap-Tap 与 US-Tap 相比，在术后 72 小时内均可提供相似的术后镇痛效果。
