Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
North Allegheny Senior High School, Pittsburgh, Pennsylvania.
Surg Obes Relat Dis. 2023 Aug;19(8):851-857. doi: 10.1016/j.soard.2023.01.014. Epub 2023 Jan 20.
Bariatric surgical patients are vulnerable to cardiopulmonary depressant effects of opioids. The enhanced recovery after surgery (ERAS) protocol to improve postoperative morbidity recommends regional anesthesia for postoperative pain management. However, there is limited evidence that peripheral nerve blocks (PNB) have added benefit.
Study the effect of PNB on postoperative pain and opioid use following bariatric surgery.
Academic medical center, United States.
We conducted a cohort study of patients who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. A total of 44 patients received the control ERAS protocol with preoperative oral extended-release morphine sulfate (MS), while 45 patients underwent a PNB with either intrathecal morphine (IM) or oral MS per local ERAS protocol. The PNB group either underwent preoperative bilateral T7 paravertebral (PVT) PNBs (27 patients) with IM or postoperative transversus abdominis plane (TAP) PNBs (18 patients) with oral MS. The primary outcome compared total opioid consumption between the ERAS control group and the PNB group up to 48 hours postoperatively. Secondary outcomes included comparison by block type and postoperative pain scores.
PVT or TAP PNB patients had a reduction in mean postoperative oral morphine equivalent (OME) requirements compared with the ERAS protocol cohort at 24 hours (93.9 versus 42.8 mg), P < .0001; at 48 hours (72.6 versus 40.5 mg); and in pain scores at 24 hours (5.64/10 versus 4.46/10), P = .02. OME and pain scores were higher in the SG cohort.
Addition of truncal PNB to standard ERAS protocol for bariatric surgical patients reduces postoperative total opioid consumption.
减重手术患者易受到阿片类药物心肺抑制作用的影响。旨在改善术后发病率的术后加速康复（ERAS）方案建议对术后疼痛进行区域麻醉管理。然而，关于外周神经阻滞（PNB）有额外获益的证据有限。
研究 PNB 对减重手术后疼痛和阿片类药物使用的影响。
美国学术医疗中心。
我们对接受袖状胃切除术（SG）或 Roux-en-Y 胃旁路术（RYGB）的患者进行了队列研究。共有 44 例患者接受了术前口服延长释放吗啡硫酸盐（MS）的常规 ERAS 方案，而 45 例患者则根据当地 ERAS 方案进行了 PNB，包括鞘内吗啡（IM）或口服 MS。PNB 组患者术前接受双侧 T7 椎旁（PVT）PNB（27 例）加 IM 或术后接受经腹横肌平面（TAP）PNB（18 例）加口服 MS。主要结局是比较术后 48 小时内 ERAS 对照组和 PNB 组的总阿片类药物消耗量。次要结局包括按阻滞类型和术后疼痛评分进行比较。
与 ERAS 方案组相比，PVT 或 TAP PNB 患者在术后 24 小时（93.9 比 42.8mg，P<0.0001）、术后 48 小时（72.6 比 40.5mg）和术后 24 小时（5.64/10 比 4.46/10）的口服吗啡等效物（OME）需求减少，P<0.0001。SG 组的 OME 和疼痛评分更高。
将躯干 PNB 加入到减重手术患者的标准 ERAS 方案中可以减少术后总阿片类药物的消耗。
