【罂粟摘要】术前与术后使用0.25%布比卡因腹横肌平面阻滞对术后阿片类药物使用影响的比较：一项回顾性研究
术前与术后使用0.25%布比卡因腹横肌平面阻滞对术后阿片类药物使用影响的比较：一项回顾性研究
贵州医科大学 高鸿教授课题组
翻译：张中伟 修改：吴学艳 编辑：佟睿 审校：曹莹
加速康复的多模式镇痛优化方案包括腹横肌平面(TAP)阻滞，本研究的主要目的是评估术前与术后使用0.25%布比卡因TAP阻滞对结、直肠术后阿片类药物使用的影响。
一项回顾性队列研究，比较患者术前(n=240)和术后(n=22)接受0.25%布比卡因TAP阻滞术后使用阿片类药物情况。该研究在一家三级医疗机构进行，纳入2018年8月至2020年1月期间接受结肠直肠切除术的患者进行研究。此研究主要结果是术后阿片类药物的使用情况，次要结果包括手术细节、住院时长、再手术和再入院率。
与术前接受TAP阻滞患者相比，术后接受0.25%布比卡因TAP阻滞患者自控镇痛(PCA)可能性小，为(59.1% vs 83.3%，p=0.012)；出院时使用阿片类药物需求减少，为(6.4% vs 16.9%，p=0.004)。手术后按需给予阿片类药物用量明显减少，为(84.5 vs 32.0 mg，p=0.047)。术后PCA使用时间、口服阿片类药物使用量和住院时长方面无显著差异。
术后0.25%布比卡因TAP阻滞与术后PCA和出院阿片类药物需求显著降低相关。总的住院时长不受TAP阻滞时间影响；由于本研究的样本量有限，结论不能一概而论，需要进行更多的研究。
原始文献来源：
Richard Kalu, Peter Boateng, Lauren Carrier，et al. Effect of preoperative versus postoperative use of transversus abdominis plane block with plain 0.25 % bupivacaine on postoperative opioid use: a retrospective study.BMC Anesthesiology， (2021) 21:114.
Effect of preoperative versus postoperativeuse of transversus abdominis plane block with plain 0.25 % bupivacaine on postoperative opioid use: a retrospective study
Background: Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs. postoperative plain 0.25 % bupivacaine TAP block on postoperative opioid use after colorectal surgery.
Methods: A retrospective cohort study comparing postoperative opioid use in patients who received preoperative (n = 240) vs. postoperative (n = 22) plain 0.25 % bupivacaine TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The primary outcome of the study was postoperative opioid use. Secondary outcomes included operative details, length of stay, reoperation, and readmission rates.
Results: Patients who received postoperative plain 0.25 % bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1 % vs. 83.3 %; p = 0.012) and opioid medications on discharge (6.4 % vs. 16.9 %; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs. 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral opioid use, and length of stay.
Conclusions: Plain 0.25 % bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge opioid medications. The overall hospital length of stay was not affected by the timing of TAP block. Because of the limited sample size in this study, conclusions cannot be
generalized, and more research will be required.