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首页> 外文期刊>Surgical Endoscopy >Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain management
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Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain management

机译：使用脂质体Bupivaine作为非阿片类药物止痛药的横向腹部肿瘤，用于术后疼痛管理

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IntroductionThe use of non-narcotic modalities for postoperative analgesia may decrease exposure to opioids, thereby limiting their deleterious effects. The objective of this study was to determine the effectiveness of a liposomal bupivacaine transverse abdominis plane (TAP) block prior to laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB). The primary outcome was total postoperative morphine equivalents.MethodsA single-surgeon, IRB-approved retrospective chart review was performed on consecutive patients who underwent LRYGB or LSG from 2010 to 2016. Patients were grouped according to those who received TAP blocks immediately preoperatively with rescue opioids (TAP group) and those who received PCA only (PCA group). Total parenteral morphine equivalents (PME) were calculated. Numerical pain scores were collected immediately following surgery, 12h postoperatively, and on the day of discharge. Median length of stay (LOS) and 30-day readmissions were also calculated.ResultsThere were 440 patients who met inclusion criteria. The TAP group had significantly less opioid use (total PME) than the PCA, irrespective of surgical approach (70.42.7 PCA LRYGB and 26.51.5 TAP block LRYGB, p value <= 0.0001; 60.0 +/- 3.5 PCA LSG vs. and 24.1 +/- 2.0 TAP block LSG, p value<0.0001). Median LOS was 2.0 days for both PCA groups, whereas LOS decreased to 1.0day for both groups of patients receiving TAP blocks (p<0.0001). Pain scores immediately following and 12h after surgery were significantly elevated in the TAP LRYGB versus PCA LRYGB (p<0.05) and immediately following surgery for PCA versus TAP block for LSG (p=0.0109).Conclusions TAP blocks with liposomal bupivacaine lead to significantly less use of parenteral morphine equivalents and decreased LOS compared to PCA alone. Pain scores were higher in the TAP LRYGB group compared to the LRYGB PCA group, with no differences in pain scores noted in the LSG groups.
机译：简介术后镇痛的非麻醉剂量的使用可能会降低对阿片类药物的暴露，从而限制了他们的有害效果。本研究的目的是确定腹腔镜套管胃切除术（LSG）和腹腔镜胃旁路（LARRGB）之前脂质体Bupivaine横向腹平面（TAP）嵌段的有效性。主要结果是总体术后吗啡等价物。在2010年至2016年的连续患者中，IRB批准的回顾性图表审查进行了IRB批准的回顾性图表审查。患者根据那些通过抢救表阿片的立即接受TAP块的人进行分组（点击组）和仅接收PCA的人（PCA组）。计算全肠病肠外吗啡等价物（PME）。术后12小时后立即收集数值疼痛评分，并在排出日。中位数逗留长度（LOS）和30天的阅约度也被计算出。符合440名符合纳入标准的患者。无论手术方法如何（70.42.7 pca lrygb和26.51.5点击块lrygb，p值<= 0.0001; 60.0 +/- 3.5 PCA LSG与PCA，Tap组24.1 +/- 2.0点击块LSG，P值<0.0001）。两个PCA组中位数LOS为2.0天，而洛杉矶均减少至1.0day，两组患者接受抽头块（P <0.0001）。疼痛分数在手术后立即进行疼痛分数显着升高，在龙头树胶与pca lrygb（p <0.05）后，并立即跟踪PCA的手术，LSG与抽头块（P = 0.0109）。结论脂质体Bupivacaine的嵌段块导致显着较低与单独的PCA相比，使用肠外吗啡等价物并减少洛杉矶。与LryGB PCA组相比，Tap Lrygb组疼痛评分较高，LSG组中没有疼痛评分没有差异。

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