腹横肌平面阻滞对病态性肥胖患者腹腔镜胃袖状切除术后恶心呕吐的影响

Transversus abdominis plane block reduce post-operative nausea and vomiting after laparoscopic sleeve gastrectomy in morbid obesity patients

目的研究超声引导下腹横肌平面阻滞(transversus abdominis plane block,TAPB)对肥胖患者腹腔镜胃袖状切除(laparoscopic sleeve gastrectomy,LSG)术后恶心呕吐(post-operative nausea and vomiting,PONV)的影响。方法选择2017年1月至2022年1月于天津医科大学总医院普通外科接受LSG手术的患者285例,以随机数字表法分为两组,其中TAPB组145例注射罗哌卡因注射液,对照组140例注射生理盐水。比较TAPB组和对照组手术相关指标、术后急性疼痛评估及术后恢复情况。结果两组患者ASA分级、手术时长、苏醒时间、拔管时间、术中血流动力学指标差异均无统计学意义。TAPB组术中瑞芬太尼[(2.0±0.6)vs(2.9±0.9)mg]、舒芬太尼[(24.7±2.5)vs(50.0±3.2)μg]和右美托咪定[(60.0±0.4)vs(65.0±0.5)μg]用量较对照组明显减少,丙泊酚用量差异均无统计学意义。TAPB组术后1、3、6、12、24、48 h静息状态和体动状态的VAS评分和NRS评分均明显低于对照组。TAPB组自控镇痛泵(patient-controlled intravenous analgesia,PCIA)首次使用时间显著延长[(2.0±0.8)vs(1.1±0.9)h],48 h内PCIA有效按压次数[(3±1)vs(5±2)次]及病房补救镇痛发生率(19.3%vs 31.4%)明显低于对照组。TAPB组PONV发生频率[(3.0±1.5)vs(3.6±1.8)次]、严重程度(2.8±1.4 vs 3.4±1.8)和追加止吐药物发生率(15.9%vs 27.9%)明显低于对照组。TAPB组术后首次下床活动时间[(1.4±0.3)vs(1.5±0.3)h]和排气时间[(1.2±0.9)vs(1.4±1.0)h]明显早于对照组。术后住院时长差异无统计学意义。结论TAPB用于LSG可明显减轻术后的疼痛及PONV,减少术后阿片类止痛药与止吐药使用,促进患者康复。

Objective To study the effect of ultrasound guided transabdominal plane block(TAPB)on postoperative nausea and vomiting(PONV)in obese patients after laparoscopic sleeve gastrectomy(LSG).Methods From Jan.2017 to Jan.2022,285 patients who underwent LSG surgery in the Department of General Surgery,Tianjin Medical University General Hospital were selected and randomly divided into two groups,including 145 patients in TAPB group and 140 patients in the control group(The TAPB group was injected with ropivacaine;the control group injected with physiological saline).Data between TAPB group and control group were compared,including operation related data,postoperative acute pain assessment,and postoperative recovery assessment.Results There was no significant difference between the two groups in ASA grading,operation duration,awakening time,extubation time or intraoperative hemodynamic index.The dosage of remifentanil[(2.0±0.6)vs(2.9±0.9)mg],sufentanil[(24.7±2.5)vs(50.0±3.2)μg],and dexmedetomidine[(60.0±0.4)vs(65.0±0.5)μg]in TAPB group was significantly reduced compared with that in the control group,and there was no significant difference in the dosage of propofol.The VAS score and NRS score of resting state and motor state in TAPB group at 1,3,6,12,24,48 h after operation were significantly lower than those in the control group.In TAPB group,the first use time of PCIA[(2.0±0.8)vs(1.1±0.9)h]was significantly prolonged,the number of effective pressing of PCIA(3±1 vs 5±2)within 48 hours and the incidence of rescue analgesia in wards(19.3%vs 31.4%)were significantly lower than those in the control group.The frequency(3.0±1.5 vs 3.6±1.8)and severity(2.8±1.4 vs 3.4±1.8)of PONV and the incidence of additional antiemetic drugs(15.9%vs 27.9%)in TAPB group were significantly lower than those in the control group.The ambulation time[(1.4±0.3)vs(1.5±0.3)h]and exhaust time[(1.2±0.9)vs(1.4±1.0)h]in TAPB group was significantly earlier than those in the control group.There was no significant difference in postoperative length of hospitalization.Conclusion TAPB for LSG can significantly reduce postoperative pain and PONV,reduce the use of opioid analgesics and antiemetics,and promote recovery of patients.