BACKGROUND The morbidly obese (MO) patient presents a unique challenge to pain control in the postoperative period due to associated comorbidities and the amplified impact of opiates. In order to reduce potential complications associated with narcotic use in the MO patient, multimodal analgesia has been advocated. In this study, we examined the effect of laparoscopic-guided transversus abdominis plane block (LG TAP) for further optimizing multimodal pain control. METHODS This is a retrospective analysis of a prospectively collected database of 140 consecutive patients undergoing LSG without TAP block (pre-TAP group) compared to 131 patients undergoing LSG with LGTAP (TAP group). All operations were performed laparoscopically utilizing uniform clinical pathways. Baseline characteristics for both groups were comparable. Both groups received standardized anesthesia. Outcomes included time to postoperative ambulation, pain scores, PCA volume, length of hospital stay, utilization of oral opiate medications, and return to activity (RTA). RESULTS Pre-TAP versus TAP groups were comparable, mean age 42 years (p = 0.99), women 81.4% versus 87.8% (p = 0.148), mean BMI (kg/m2) 46 versus 45 (p = 0.394). Most patients ambulated within 2 h after arrival to the floor (87.9% vs. 76.3%, p = 0.013). On postoperative day (POD) 1, mean reported pain score (0-10) was 4.50 vs. 5.06 (p = 0.063) and a mean PCA morphine used for 24 h was 26.3 mL versus 26 mL, p = 0.35. Mean days of postoperative opiate medication were 2.19 versus 1.24 (p < 0.001). Return to activity was 2.81 versus 2.08 days (p < 0.001). When controlled for age, BMI, OR time, PCA volume used, and average pain score, TAP block was an independent predictor of earlier return to activities (p < 0.001). CONCLUSIONS LGTAP block following LSG is an additional valuable modality of pain control in the perioperative period. Our study shows that TAP block is associated with an earlier RTA and decreased opiate use in patients undergoing LSG.

中文翻译：

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腹腔镜袖套胃切除术后腹腔镜引导的横贯腹部平面阻滞与早期恢复活动有关：一项对271例患者的研究。

背景技术由于相关的合并症和阿片类药物的扩大影响，病态肥胖（MO）患者在术后期间对疼痛控制提出了独特的挑战。为了减少在MO患者中与麻醉性使用相关的潜在并发症，已提倡多模式镇痛。在这项研究中，我们检查了腹腔镜引导的腹横肌平面阻滞（LG TAP）的效果，以进一步优化多模式疼痛控制。方法这是一项前瞻性收集的数据库的回顾性分析，该数据库收集了140例接受无TAP阻滞的LSG的连续患者（TAP前组）与131例接受LGTAP的LSG的患者（TAP组）。所有手术均通过腹腔镜采用统一的临床途径进行。两组的基线特征是可比较的。两组均接受标准麻醉。结果包括术后移动时间，疼痛评分，PCA量，住院时间，口服鸦片类药物的使用以及恢复活动（RTA）。结果TAP组与TAP组相当，平均年龄42岁（p = 0.99），女性81.4％对87.8％（p = 0.148），平均BMI（kg / m2）46对45（p = 0.394）。大多数患者在到达地板后2小时之内走动（87.9％对76.3％，p = 0.013）。术后第1天（POD），报告的平均疼痛评分（0-10）为4.50 vs. 5.06（p = 0.063），平均24小时使用的PCA吗啡为26.3 mL对26 mL，p = 0.35。鸦片类药物术后平均天数为2.19比1.24（p <0.001）。恢复活动的时间为2.81天和2.08天（p <0.001）。在控制年龄，BMI，OR时间，使用的PCA量后，与平均疼痛评分相比，TAP阻滞是较早恢复活动的独立预测因子（p <0.001）。结论LSG术后LGTAP阻滞是围手术期疼痛控制的另一种有价值的方式。我们的研究表明，接受LSG的患者中，TAP阻滞与更早的RTA和降低的阿片类药物使用有关。