Department of Anesthesiology, Hunter Holmes McGuire VA Medical, 1201 Broad Rock Blvd, Richmond, VA, 23249, USA.
Department of Anesthesiology, Virginia Commonwealth University Medical Center, 1200 E. Broad St, 7th Floor, North Wing, PO Box 980695, Richmond, VA, 23298, USA.
J Robot Surg. 2023 Aug;17(4):1817-1823. doi: 10.1007/s11701-023-01598-8. Epub 2023 Apr 21.
As robotic prostatectomy surgery becomes more prevalent, it is important to identify any regional techniques to optimize patient's recovery. We evaluated the effectiveness of bilateral transversus abdominis plane (TAP) and rectus sheath (RS) blocks with liposomal bupivacaine. We hypothesized that these blocks would reduce perioperative opioid use and pain scores. A retrospective cohort of patients from May 2018 and May 2021 at a single large VA hospital were studied. We compared those not receiving a nerve block against those receiving the TAP and RS as part of an Enhanced Recovery After Surgery (ERAS) pathway starting in May 2019. The primary outcome was post-operative opioid use. Secondary outcomes were post-operative pain scores and hospital length of stay. One hundred and thirty-four patients were included in the final analysis. Eighty-one patients did not receive a block and fifty-three patients did receive a block. No difference existed between the groups in regard to median oral morphine equivalents (mg) used in PACU or any post-operative day. No difference existed in median opioid usage (mg) or pain scores between the two groups on any post-operative day. There was no difference in temporal association of median pain scores or narcotic usage between the two groups. Bilateral TAP and RS with liposomal bupivacaine did not significantly decrease post-operative opioid use, improve pain scores, or decrease hospital length of stay for patients undergoing robotic prostatectomy. Further studies need to be done to evaluate the effect of these blocks with liposomal bupivacaine.
随着机器人前列腺切除术的普及，确定任何优化患者恢复的区域技术变得尤为重要。我们评估了双侧腹横肌平面（TAP）和腹直肌鞘（RS）阻滞联合脂质体布比卡因的效果。我们假设这些阻滞将减少围手术期阿片类药物的使用和疼痛评分。这项回顾性队列研究纳入了 2018 年 5 月至 2021 年 5 月期间在一家大型退伍军人事务部医院的患者。我们将未接受神经阻滞的患者与在 2019 年 5 月开始接受增强术后康复（ERAS）途径的 TAP 和 RS 阻滞的患者进行了比较。主要结果是术后阿片类药物的使用。次要结果是术后疼痛评分和住院时间。最终分析纳入了 134 例患者。81 例患者未接受阻滞，53 例患者接受了阻滞。两组患者在 PACU 或任何术后天的中位数口服吗啡等效物（mg）使用量方面没有差异。两组患者在任何术后天的中位数阿片类药物使用量（mg）或疼痛评分方面没有差异。两组患者的中位数疼痛评分或阿片类药物使用的时间关联也没有差异。双侧 TAP 和 RS 阻滞联合脂质体布比卡因并未显著减少机器人前列腺切除术患者术后阿片类药物的使用、改善疼痛评分或缩短住院时间。需要进一步研究评估这些脂质体布比卡因阻滞的效果。
