Department of Anesthesiology & Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Clin Transplant. 2024 Jan;38(1):e15227. doi: 10.1111/ctr.15227.
Transplantation surgery continues to evolve and improve through advancements in transplant technique and technology. With the increased availability of ultrasound machines as well as the continued development of Enhanced Recovery after Surgery (ERAS) protocols, regional anesthesia has become an essential component of providing analgesia and minimizing opioid use perioperatively. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures. To date, no formal guidelines or recommendations exist which address the use of regional anesthesia in transplantation surgery. In response, the Society for the Advancement of Transplant Anesthesia (SATA) identified experts in both transplantation surgery and regional anesthesia to review available literature concerning these topics. The goal of this task force was to provide an overview of these publications to help guide transplantation anesthesiologists in utilizing regional anesthesia. The literature search encompassed most transplantation surgeries currently performed and the multitude of associated regional anesthetic techniques. Outcomes analyzed included analgesic effectiveness of the blocks, reduction in other analgesic modalities-particularly opioid use, improvement in patient hemodynamics, as well as associated complications. The findings summarized in this systemic review support the use of regional anesthesia for postoperative pain control after transplantation surgeries. Part 1 of the manuscript focused on regional anesthesia performed in thoracic transplantation surgeries, and part 2 in abdominal transplantations. Specifically, regional anesthesia in liver, kidney, pancreas, intestinal, and uterus transplants or applicable surgeries are discussed.
移植手术通过移植技术和技术的进步不断发展和完善。随着超声机的广泛应用以及术后强化恢复（ERAS）方案的不断发展，区域麻醉已成为提供镇痛和最大限度减少围手术期阿片类药物使用的重要组成部分。许多中心目前在移植手术中使用外周和神经轴阻滞，但这些技术远未标准化。这些程序的使用通常取决于移植中心的历史方法和围手术期文化。迄今为止，尚无正式的指南或建议涉及移植手术中区域麻醉的使用。为此，移植麻醉学会（SATA）召集了移植手术和区域麻醉方面的专家，对这些主题的现有文献进行了审查。该工作组的目标是提供这些出版物的概述，以帮助指导移植麻醉师使用区域麻醉。文献检索涵盖了目前进行的大多数移植手术以及多种相关的区域麻醉技术。分析的结果包括阻滞的镇痛效果、其他镇痛方式（特别是阿片类药物的使用）减少、患者血液动力学改善以及相关并发症。本系统评价总结的研究结果支持在移植手术后使用区域麻醉来控制术后疼痛。本文的第一部分侧重于胸部移植手术中的区域麻醉，第二部分侧重于腹部移植手术。具体讨论了肝、肾、胰腺、肠和子宫移植或适用手术中的区域麻醉。
