Efficacy of transversus abdominis plane block with liposomal bupivacaine during open abdominal wall reconstruction
Efficacy of transversus abdominis plane block with liposomal bupivacaine during open abdominal wall reconstruction
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DOI：
10.1016/j.amjsurg.2015.12.026
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发表时间：
2016-09-01
影响因子：
3
通讯作者：
Novitsky, Yuri W.
中科院分区：
文献类型：
--
作者：
Fayezizadeh, Mojtaba;Majumder, Arnab;Novitsky, Yuri W.
背景：腹横肌平面阻滞（TAPb）是一种用于腹部外科手术的镇痛辅助药物。脂质体布比卡因（LB）表现出延长的镇痛作用，长达72小时。我们评估了TAPb使用LB对接受开放式腹壁重建术（AWR）的患者的镇痛效果。方法：将50例接受AWR的患者与使用LB的TAPb（TAP组）进行比较，并与接受AWR而不使用TAPb的匹配历史队列（对照组）进行比较。结果的措施包括术后使用的吗啡等效物，数字评分量表疼痛评分，口服麻醉剂的时间，和住院时间（LOS.RESULTS：队列人口统计学匹配。没有与TAPb或LB相关的并发症。TAP组在手术日的麻醉剂需求显著减少（9.5 mg vs 16.5 mg，P = .004），术后第1天（POD）（26.7 mg vs 39.5 mg，P = .01）和POD2（29.6 mg vs 40.7 mg，P = 0.047）和手术日疼痛评分（5.1 vs 7.0，P <0.001）、POD1（4.2 vs 5.5，P = 0.002）和POD2（3.9 vs 4.8，P = 0.04）。此外，TAP组表现出明显更短的时间口服麻醉剂（2.7天对4.0天，P <0.001）和中位数LOS（5.2天对6.8天，P = 0.004）。结论：TAPb与LB表现出显着减少麻醉剂消耗和改善疼痛控制。TAPb允许更早停止静脉麻醉剂和更短的LOS。术中TAPb联合LB似乎是接受开放式AWR患者围手术期镇痛的有效辅助措施。(C)2016 Elsevier Inc. All rights reserved.
BACKGROUND: Transversus abdominis plane block (TAPb) is an analgesic adjunct used for abdominal surgical procedures. Liposomal bupivacaine (LB) demonstrates prolonged analgesic effects, up to 72 hours. We evaluated the analgesic efficacy of TAPb using LB for patients undergoing open abdominal wall reconstruction (AWR).METHODS: Fifty patients undergoing AWR with TAPb using LB (TAP-group) were compared with a matched historical cohort undergoing AWR without TAPb (control group). Outcome measures included postoperative utilization of morphine equivalents, numerical rating scale pain scores, time to oral narcotics, and length of stay (LOS).RESULTS: Cohorts were matched demographically. No complications were associated with TAPb or LB. TAP-group evidenced significantly reduced narcotic requirements on operative day (9.5 mg vs 16.5 mg, P = .004), postoperative day (POD) 1 (26.7 mg vs 39.5 mg, P = .01) and POD2 (29.6 mg vs 40.7 mg, P = .047) and pain scores on operative day (5.1 vs 7.0, P < .001), POD1 (4.2 vs 5.5, P = .002), and POD2 (3.9 vs 4.8, P = .04). In addition, TAP-group demonstrated significantly shorter time to oral narcotics (2.7 days vs 4.0 days, P < .001) and median LOS (5.2 days vs 6.8 days, P = .004).CONCLUSIONS: TAPb with LB demonstrated significant reductions in narcotic consumption and improved pain control. TAPb allowed for earlier discontinuation of intravenous narcotics and shorter LOS. Intraoperative TAPb with LB appears to be an effective adjunct for perioperative analgesia in patients undergoing open AWR. (C) 2016 Elsevier Inc. All rights reserved.