GRC 29, AP-HP, DMU DREAM and Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
GRC 29, AP-HP, DMU DREAM and Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
Reg Anesth Pain Med. 2023 Jul;48(7):352-358. doi: 10.1136/rapm-2022-103705. Epub 2023 Jan 17.
Postoperative pain management after orthotopic liver transplantation is complex due to impaired liver function and frequent acute kidney dysfunction. Subcostal transversus abdominis plane (TAP) block may be of interest in this population. The aim of this study was to evaluate the impact of subcostal TAP block on opioid consumption after liver transplantation.
We conducted a before-and-after single center study. During the first period, we included patients whom did not receive an analgesic TAP block. During the second period, we included those with bilateral ultrasound-guided subcostal TAP block (20 mL ropivacaïne 0.2% each side). Patients requiring sedation within 48 hours of surgery as well as patients with combined liver and kidney transplants or skin-only closures were excluded. The primary outcome was cumulative oral morphine consumption within 48 hours after surgery. Secondary outcomes included pain scores and TAP block-related complications.
A total of 132 patients were included in the non-TAP block group and 78 patients in the TAP block group. The median oral morphine equivalent consumption (IQR) within 48 hours following surgery was 74 mg (39; 112) for the non-TAP block group and 50 mg (20; 80) for the TAP block group (p<0.001). There was no difference in pain scores between the two groups. No complications related to the TAP block were reported.
Subcostal TAP block appears to have a small opioid reducing effect after orthotopic liver transplantation surgery.
由于肝功能受损和频繁的急性肾功能障碍，肝移植术后的疼痛管理较为复杂。肋缘下腹横肌平面（TAP）阻滞可能对此类人群有意义。本研究旨在评估肋缘下 TAP 阻滞对肝移植术后阿片类药物消耗的影响。
我们进行了一项前后对照的单中心研究。在第一阶段，我们纳入了未接受镇痛 TAP 阻滞的患者。在第二阶段，我们纳入了接受双侧超声引导肋缘下 TAP 阻滞（每侧 20ml 罗哌卡因 0.2%）的患者。排除需要在手术后 48 小时内镇静的患者以及接受肝肾联合移植或仅皮肤闭合的患者。主要结局是术后 48 小时内口服吗啡的累积消耗量。次要结局包括疼痛评分和 TAP 阻滞相关并发症。
共有 132 例患者纳入非 TAP 阻滞组，78 例患者纳入 TAP 阻滞组。非 TAP 阻滞组术后 48 小时内口服吗啡等效剂量（IQR）中位数为 74mg（39；112），TAP 阻滞组为 50mg（20；80）（p<0.001）。两组疼痛评分无差异。未报告与 TAP 阻滞相关的并发症。
肋缘下 TAP 阻滞似乎对肝移植术后有较小的阿片类药物减少作用。
