Zhou Xia, Feng Wei, Wang Xiaolong, Niu Zejun, Wang Peng, Yuan Li, Wang Pei
Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province,People's Republic of China.
Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China.
J Pain Res. 2024 Sep 4;17:2881-2890. doi: 10.2147/JPR.S471813. eCollection 2024.
Anesthesia for metabolic-bariatric surgery is challenging due to the increased risk of opioid-related adverse events. The purpose of the investigation was to assess the feasibility and efficacy of multimodal opioid-free general anesthesia with transversus abdominis plane (TAP) block for laparoscopic sleeve gastrectomy in contrast with conventional opioid-based general anesthesia.
Eighty patients who underwent laparoscopic sleeve gastrectomy and eventually 71 patients included in the analysis. They were randomly divided into an opioid-based anesthesia group (control group) with sufentanil or opioid-free anesthesia (OFA) group. Esketamine, dexmedetomidine, and TAP were as part of the OFA. Sevoflurane, dexamethasone, and muscle relaxants were administered intraoperatively to all patients. The primary outcome was antiemetic rescue within 24 hours after surgery. The secondary outcomes included pain scores, analgesic needs, extubation time, complications, the hemodynamic changes, and duration of hospital stay.
In contrast with the control group, the need for antiemetic rescue was significantly reduced ( 0.035). Furthermore, the visual Analog Scale (VAS) for postoperative pain was considerably lower in the OFA group ( <0.01) than it was in the control group. There was no significant difference in the need for analgesic rescue in both groups (p= 0.155). Extubation time and post-anesthesia care unit (PACU) stay duration were equal between the two groups ( =0.328 and =0.54). At the end of the surgery and after extubation, hemodynamic changes was more pronounced in the OFA group ( =0.027) than the control group. The length of the hospital stay was significantly shorter compared with the control group (p =0.002).
OFA with TAP results in a significant decrease in the need for antiemetic rescue, a lower level of pain after the surgery, and a shorter hospital stay in contrast with anesthesia based on opioids.
由于阿片类药物相关不良事件风险增加，代谢性减重手术的麻醉具有挑战性。本研究的目的是评估与传统阿片类药物全身麻醉相比，多模式无阿片类全身麻醉联合腹横肌平面（TAP）阻滞用于腹腔镜袖状胃切除术的可行性和有效性。
80例行腹腔镜袖状胃切除术的患者最终71例纳入分析。他们被随机分为阿片类药物麻醉组（对照组），使用舒芬太尼，或无阿片类药物麻醉（OFA）组。艾司氯胺酮、右美托咪定和TAP阻滞是OFA的一部分。所有患者术中均给予七氟烷、地塞米松和肌肉松弛剂。主要结局是术后24小时内的止吐补救措施。次要结局包括疼痛评分、镇痛需求、拔管时间、并发症、血流动力学变化和住院时间。
与对照组相比，止吐补救措施的需求显著降低（0.035）。此外，OFA组术后疼痛的视觉模拟评分（VAS）显著低于对照组（<0.01）。两组镇痛补救措施的需求无显著差异（p = 0.155）。两组的拔管时间和麻醉后监护病房（PACU）停留时间相等（=0.328和=0.54）。手术结束时和拔管后，OFA组的血流动力学变化比对照组更明显（=0.027）。住院时间与对照组相比显著缩短（p = 0.002）。
与基于阿片类药物的麻醉相比，联合TAP阻滞的OFA可显著降低止吐补救措施的需求，术后疼痛程度更低，住院时间更短。
