Transversus abdominis plane block reduce postoperative acute pain and prevents chronic post-surgical pain after sleeve gastrectomy.

doi:10.3877/cma.j.issn.2095-9605.2021.04.002

Abstract

Abstract:

Objective

To study the effect of transversus abdominal plane (TAP) block on acute postoperative pain, chronic post-surgical pain (CPSP) and postoperative recovery of weight loss patients.

Methods

Laparoscopic sleeve gastrectomy was performed in the Second Affiliated Hospital of Anhui Medical University from November 2019 to November 2020. The patients were randomly divided into general anesthesia group (GA group) and general anesthesia combined with transverse abdominal muscle plane block group (TAP group), with 75 cases in each group. The visual analogue Scale (VAS), effective pressure times of analgesia pump within 48 hours after operation, incidence of remedial analgesia in postoperative ward, post-operative nausea and number of vomiting (PONV), Pittsburgh sleep quality index (PSQI) score 3 days after operation and CPSP incidence 3 and 6 months after operation were compared between the two groups. Among them, CPSP data were obtained by telephone follow-up.

Results

Compared with GA group, VAS scores in TAP group decreased significantly at 1, 6, 12, 24 hours after operation, the effective times of analgesia pump and the incidence of remedial analgesia in postoperative ward decreased significantly within 48 hours after operation, and the incidence of PONV decreased significantly after operation. The 3 days after operation PSQI score decreased significantly (P<0.05). The incidence of CPSP in TAP group was significantly lower than that in GA group at 3 and 6 months after operation (P<0.05).

Conclusions

TAP block can effectively reduce postoperative acute pain, reduce the dosage of opioids, improve postoperative sleep quality. TAP block may prevent postoperative chronic pain in patients with weight loss.

Key words: Transversus abdominis plane block, Laparoscopic sleeve gastrectomy, Postoperative acute pain, Chronic post-surgical pain, Sleep disorders

Junjun Zhu, Chunxia Huang, Xianwen Hu. Transversus abdominis plane block reduce postoperative acute pain and prevents chronic post-surgical pain after sleeve gastrectomy.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(04): 227-231.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2021.04.002

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2021/V07/I04/227

Figures/Tables 3

References 20

[1]	Damsgaard CT, Michaelsen KF, Molbo D, et al. Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants [J]. The Lancet, 2016, 387(10026): 1377-1396.
[2]	杨华, 陈缘, 董志勇, 等. 中国肥胖代谢外科数据库: 2020年度报告[J/CD]. 中华肥胖与代谢病电子杂志, 2021,7(1):1-7.
[3]	Fldi M, Soós A, Hegyi P, et al. Transversus abdominis plane block appears to be effective and safe as a part of multimodal analgesia in bariatric surgery: A meta-analysis and systematic review of randomized controlled trials [J]. Obesity Surgery, 2021, 31(2): 531-543.
[4]	Mark J, Argentieri DM, Gutierrez CA, et al. Ultrarestrictive opioid prescription protocol for pain management after gynecologic and abdominal surgery [J]. Jama Network Open, 2018, 1(8): e185452.
[5]	Baeriswyl M, Zeiter F, Piubellini D, et al. The analgesic efficacy of transverse abdominis plane block versus epidural analgesia: A systematic review with meta-analysis [J]. Medicine, 2018, 97: e11261.
[6]	Ghiasi F, Ghaleh BA, Salami , et al. Effects of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass on the improvement of sleep quality, daytime sleepiness, and obstructive sleep apnea in a six-month follow-up [J]. Tanaffos, 2020, 19(1): 50-59.
[7]	Schug SA, Lavand'homme P, Barke A, et al. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain [J]. Pain, 2018, 160(1): 45-52.
[8]	Rafi AN. Abdominal field block: A new approach via the lumbar triangle [J]. Anaesthesia, 2001, 56(10): 1024-1026.
[9]	Ruiz-Tovar J, Garcia A, Ferrigni C, et al. Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block as Part of Multi-modal Analgesia in Laparoscopic Roux-en-Y Gastric Bypass Within an Enhanced Recovery After Surgery (ERAS) Program: a Prospective Randomized Clinical Trial [J]. Obesity Surgery, 2018, 28(11): 3374-3379.
[10]	Hebbard P, Fujiwara Y, Shibata Y, et al. Ultrasound-guided transversus abdominis plane (TAP) block [J]. Anaesthesia and Intensive Care, 2007, 35(4): 616-617.
[11]	Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: Description of anatomy and clinical technique [J]. Regional Anesthesia & Pain Medicine, 2010, 35(5): 436-441.
[12]	McCarthy RJ, Ivankovich KG, Ramirez EA, et al. Association of the addition of a transversus abdominis plane block to an enhanced recovery program with opioid consumption, postoperative antiemetic use, and discharge time in patients undergoing laparoscopic bariatric surgery: A retrospective study [J]. Regional Anesthesia and Pain Medicine, 2020, 45(3): 180-186.
[13]	Ruiz-Tovar J, Garcia A, Ferrigni C, et al. Laparoscopic-Guided transversus abdominis plane (TAP) block as part of multimodal analgesia in laparoscopic Roux-en-Y gastric bypass within an enhanced recovery after surgery (ERAS) program: A prospective randomized clinical trial [J]. Obesity Surgery, 2018, 28(11): 3374-3379.
[14]	Tarun M, Ashish D, Rahul S, et al. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: A randomized single blinded case control study [J]. Surgical Endoscopy, 2018, 32(12): 4985-4989.
[15]	Helene B, Bruno L, Cedric M, et al. POFA trial study protocol: A multicentre, double-blind, randomised, controlled clinical trial comparing opioid-free versus opioid anaesthesia on postoperative opioid-related adverse events after major or intermediate non-cardiac surgery [J]. BMJ Open, 2018, 8(6): e020873.
[16]	王俊. 老年髋部骨折患者术后睡眠障碍的影响因素及诊疗方案研究 [J].世界睡眠医学杂志, 2020, 7(7):1183-1184.
[17]	Høgestøl IK, Chahal-Kummen M, Eribe I, et al. Chronic abdominal pain and symptoms 5 years after gastric bypass for morbid obesity [J]. Obesity Surgery, 2017, 27(6): 1438-1445.
[18]	Kehlet H. Postoperative pain, analgesia, and recovery-bedfellows that cannot be ignored [J]. Pain, 2018, 159 (suppl 1): S11-S16.
[19]	鲁义, 姚嘉茵, 龚楚链, 等. 老年髋关节置换术患者术后慢性疼痛的相关因素及其预测模型 [J]. 临床麻醉学杂志, 2019, 35(12): 1197-1200.
[20]	Boerboom SL, Ann DH, Lianne VW, et al. Preperitoneal bupivacaine infiltration reduces postoperative opioid consumption, acute pain, and chronic postsurgical pain after bariatric surgery: a randomized controlled trial [J]. Obesity Surgery, 2018, 28(10): 3102-3110.

指标	GA组	TAP组	χ²/t值	P值
VSA评分
术后1 h	2.2±1.2	1.5±1.2	5.1	<0.01
术后6 h	2.0±1.1	1.3±1.0	4.1	<0.01
术后12 h	1.9±0.7	1.3±1.1	3.6	<0.01
术后24 h	1.1±1.1	0.6±1.1	2.9	<0.05
术后48 h	0.3±0.8	0.2±0.8	0.5	>0.05
48 h内镇疼泵有效按压次数（次）	4.2±5.6	2.3±3.1	2.8	<0.05
病房补救镇痛发生率（例/%）	25（33）	12（16）	6.8	<0.01

指标	GA组	TAP组	χ²/t值	P值
VSA评分
术后1 h	2.2±1.2	1.5±1.2	5.1	<0.01
术后6 h	2.0±1.1	1.3±1.0	4.1	<0.01
术后12 h	1.9±0.7	1.3±1.1	3.6	<0.01
术后24 h	1.1±1.1	0.6±1.1	2.9	<0.05
术后48 h	0.3±0.8	0.2±0.8	0.5	>0.05
48 h内镇疼泵有效按压次数（次）	4.2±5.6	2.3±3.1	2.8	<0.05
病房补救镇痛发生率（例/%）	25（33）	12（16）	6.8	<0.01

指标	GA组	TAP组	χ²/t值	P值
例数	75	75
性别（男/女，例）	20/55	19/56	0.04	>0.05
年龄（岁）	32.4±7.3	30.4±7.5	1.6	>0.05
BMI（kg/m²）	42.2±6.1	43.3±7.5	1.2	>0.05
ASA I/II级（例）	26/49	22/53	0.5	>0.05
高血压（例/%）	44（58.7）	48（64.0）	0.5	>0.05
高血糖（例/%）	36（48.0）	34（45.3）	0.1	>0.05
高血脂（例/%）	59（78.7）	62（82.7）	0.4	>0.05
手术时长（min）	88.9±20.3	85.2±22.3	1.0	>0.05
术中丙泊酚用量（mg）	427.8±145.2	313.3±118.7	5.3	<0.01
术中瑞芬太尼用量（mg）	1.6±0.6	1.1±0.4	6.4	<0.01
术中右美托咪定用量（μg）	68.1±16.3	67.4±17.5	0.3	>0.05

指标	GA组	TAP组	χ²/t值	P值
例数	75	75
性别（男/女，例）	20/55	19/56	0.04	>0.05
年龄（岁）	32.4±7.3	30.4±7.5	1.6	>0.05
BMI（kg/m²）	42.2±6.1	43.3±7.5	1.2	>0.05
ASA I/II级（例）	26/49	22/53	0.5	>0.05
高血压（例/%）	44（58.7）	48（64.0）	0.5	>0.05
高血糖（例/%）	36（48.0）	34（45.3）	0.1	>0.05
高血脂（例/%）	59（78.7）	62（82.7）	0.4	>0.05
手术时长（min）	88.9±20.3	85.2±22.3	1.0	>0.05
术中丙泊酚用量（mg）	427.8±145.2	313.3±118.7	5.3	<0.01
术中瑞芬太尼用量（mg）	1.6±0.6	1.1±0.4	6.4	<0.01
术中右美托咪定用量（μg）	68.1±16.3	67.4±17.5	0.3	>0.05

指标	GA组	TAP组	χ²/t值	P值
术后3 d PSQI评分	6.9±3.0	5.5±2.9	3.1	<0.05
PONV（例/%）	20（34）	10（13）	9.4	<0.05
术后首次下床活动时间（h）	34.5±13.3	33.9±12.4	0.3	>0.05
术后住院时间（d）	3.8±1.4	3.5±0.7	1.9	>0.05
术后慢性疼痛（例/%）
术后3个月	22（29）	10（13）	5.7	<0.05
术后6个月	15（20）	6（8）	4.5	<0.05

Please choose a citation manager

Content to export