Drexelius Katherine, Baltic Steven, Gachigi Kennedy, Lifsey Caleb, Kelso Rebecca, Segebarth P Bradley
Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.
OrthoCarolina Spine Center, Charlotte, NC, USA.
N Am Spine Soc J. 2025 Jul 18;23:100771. doi: 10.1016/j.xnsj.2025.100771. eCollection 2025 Sep.
Anterior lumbar interbody fusion (ALIF) is an increasingly common surgical procedure for a variety of spinal pathologies. As both opioid use and healthcare costs remain major national healthcare crises, it is crucial to understand methods of effective pain management in spine surgery, including regional anesthesia. While transversus abdominis plane (TAP) blocks are also commonly performed for anterior spinal surgery, literature evaluating outcomes after TAP blocks for ALIF patients is sparse. This retrospective cohort study aims to determine the effect of TAP blocks on perioperative opioid use and hospital length of stay.
Retrospective chart review was performed for patients 18 years or older undergoing 1- or 2-level ALIF with or without posterior percutaneous instrumented fusion. Baseline demographics, surgical details, length of stay (LOS), and data on inpatient opioid use (converted to morphine milliequivalents, MME) was collected. Total MME and MME stratified by postoperative day (POD) was collected. Bivariable and multivariable regression models were used to analyze the relationship of TAP blocks with LOS and narcotic use postoperatively.
About 295 patients were included, with 102 (34.6%) undergoing TAP block and 193 (65.4%) patients without TAP block. There were no significant differences in baseline patient characteristics. Use of a TAP block had no statistically significant effect on LOS, and bivariable analysis revealed no effect when groups were analyzed by sex, age, BMI, preoperative opioid use, or number of levels fused. TAP block patients received significantly more MME on POD 0 and on combined POD 1 and 2 than those without a TAP block. Bivariable analysis did not reveal any subgroup who benefitted from a TAP block.
With the largest patient cohort reported to date, we found no statistically significant improvements in length of stay or short-term postoperative opioid usage when patients received TAP blocks for anterior lumbar interbody fusion.
腰椎前路椎间融合术（ALIF）是一种针对多种脊柱疾病越来越常见的外科手术。由于阿片类药物的使用和医疗费用仍然是国家主要的医疗危机，了解脊柱手术中有效的疼痛管理方法至关重要，包括区域麻醉。虽然腹横肌平面（TAP）阻滞也常用于前路脊柱手术，但评估ALIF患者TAP阻滞后结果的文献较少。这项回顾性队列研究旨在确定TAP阻滞对围手术期阿片类药物使用和住院时间的影响。
对18岁及以上接受单节段或双节段ALIF（无论有无后路经皮器械融合）的患者进行回顾性病历审查。收集基线人口统计学、手术细节、住院时间（LOS）以及住院期间阿片类药物使用数据（转换为吗啡毫克当量，MME）。收集术后各天（POD）的总MME和分层后的MME。采用双变量和多变量回归模型分析TAP阻滞与术后LOS和麻醉药物使用之间的关系。
共纳入约295例患者，其中102例（34.6%）接受了TAP阻滞，193例（65.4%）未接受TAP阻滞。基线患者特征无显著差异。TAP阻滞对LOS无统计学显著影响，双变量分析显示，按性别、年龄、BMI、术前阿片类药物使用情况或融合节段数进行分组分析时，该阻滞无影响。TAP阻滞患者在术后第0天以及术后第1天和第2天的合并用药量显著高于未接受TAP阻滞的患者。双变量分析未发现任何从TAP阻滞中获益的亚组。
在迄今为止报道的最大患者队列中，我们发现接受腰椎前路椎间融合术TAP阻滞的患者在住院时间或术后短期阿片类药物使用方面没有统计学上的显著改善。
