Cataldo Rita, Bruni Vincenzo, Migliorelli Sabrina, Gallo Ida Francesca, Spagnolo Giuseppe, Gibin Giulia, Borgetti Miriam, Strumia Alessandro, Ruggiero Alessandro, Pascarella Giuseppe
Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy.
Research Unit of Anesthesia and Intensive Care, Department of Medicine and Surgery, Università Campus Bio-Medico, 00128, Rome, Italy.
Obes Surg. 2024 Jul;34(7):2475-2482. doi: 10.1007/s11695-024-07292-4. Epub 2024 May 20.
Patients undergoing laparoscopic sleeve gastrectomy (LSG) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LSG in a high-volume bariatric center, applying an enhanced recovery after bariatric surgery (ERABS) pathway.
One hundred ten patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU) and at 6, 12, and 24 h after surgery. Secondary outcomes included postoperative nausea and/or vomiting (PONV), analgesic requirement, time to walking, time to flatus, length of hospital stay (LOS), and surgical complications.
No significant differences were observed between LG-TAP and placebo groups in postoperative analgesia, with a median (IQR) NRS of 2 (4.75-0) vs. 2 (5.25-0) in PACU, 5.5 (7-3) vs. 6 (7-4) at 6 h, 2 (6-0) vs. 3 (5.25-1.75) at 12 h, and 2 (3.75-0) vs. 1 (2-0) at 24 h; all p > 0.05. A significant difference was found in PONV in PACU (LG-TAP, 46%; placebo, 25%, p-value, 0.019) and at 6 h postoperatively (LG-TAP, 69%, placebo, 41%, p-value, 0.003). No differences were observed as regards other secondary outcomes.
Our results suggest that LG-TAP block is not related to more effective postoperative analgesia compared to placebo when LA-PSI is performed.
接受腹腔镜袖状胃切除术（LSG）的患者术后通常会经历中度至重度疼痛。我们在一家大型减肥中心进行了一项随机、前瞻性双盲安慰剂对照研究，采用减肥手术后加速康复（ERABS）方案，以评估LSG术后腹腔镜引导下腹横肌平面（LG-TAP）阻滞的镇痛效果。
110例患者被随机分配接受局部麻醉药（LA）或生理盐水溶液（安慰剂）的LG-TAP阻滞，两者均联合LA切口浸润（LA-PSI）。主要结局是在麻醉后护理单元（PACU）以及术后6、12和24小时测量的疼痛评分。次要结局包括术后恶心和/或呕吐（PONV）、镇痛需求、行走时间、排气时间、住院时间（LOS）和手术并发症。
LG-TAP组和安慰剂组在术后镇痛方面未观察到显著差异，PACU中数字等级量表（NRS）的中位数（四分位间距）分别为2（4.75 - 0）和2（5.25 - 0），6小时时分别为5.5（7 - 3）和6（7 - 4），12小时时分别为2（6 - 0）和3（5.25 - 1.75），24小时时分别为2（3.75 - 0）和1（2 - 0）；所有p>0.05。在PACU（LG-TAP组为46%，安慰剂组为25%，p值为0.019）和术后6小时（LG-TAP组为69%，安慰剂组为41%，p值为0.003）观察到PONV有显著差异。在其他次要结局方面未观察到差异。
我们的结果表明，当进行LA-PSI时，与安慰剂相比，LG-TAP阻滞与更有效的术后镇痛无关。
