Study of transversus abdominis plane block as part of multimodal analgesia in enhanced recovery after surgery program for patients with hepatic hydatidosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Zeling ¹ ,  CHEN Jianzhong ² , TANG Haiyan ¹ , HUANG Xia ² , YU Dinggang ² , WANG Qiong ²

1. Department of Operating Theater, People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang, Sichuan 624000, P. R. China;
2. Department of Hepatobiliary Surgery, People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang, Sichuan 624000, P. R. China;

Corresponding?author：

CHEN Jianzhong, Email: chen_jianzhong@sohu.com

Keywords：

hepatic hydatidosis; hepatectomy; enhanced recovery after surgery; transversus abdominis plane block; multimodal analgesia

DOI：

10.7507/1007-9424.202111050

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Objective To investigate the clinical effect of transversus abdominis plane (TAP) block as part of multimodal analgesia in enhanced recovery after surgery (ERAS) program for patients with hepatic hydatidosis. Methods This study was a randomized controlled trial (The registration number was ChiCTR2100053689). According to the established inclusion and exclusion criteria, the patients diagnosed with hepatic hydatidosis treated in the People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from October 2019 to August 2021 were prospectively included. The odd and even by obverse and reverse of coin was adopted to assign into the study group and the control group, respectively. The patients in the study group were treated with ERAS + TAP block + patient controlled intravenous analgesia (PCIA) + tramadol and the patients in the control group were treated with ERAS + PCIA + tramadol. The intraoperative and postoperative statuses of the two groups were compared. Results A total of 64 patients were enrolled in this study, including 32 patients in the study group and 32 patients in the control group. There were no statistical differences in the baseline data such as the age, gender, preoperative complications, preoperative liver function, and liver hydatid type between the two groups (P>0.05). The operations of 64 patients were performed successfully, and there was no perioperative death. There were no statistical differences in the operation time, intraoperative bleeding, and operation mode between the two groups (P>0.05). Compared with the control group, the points of visual analogue scale of postoperative pain on day 1 and 2 were lower (P<0.05), the dosage of tramadol within 2 d after operation and hospitalization expenses were less (P<0.05), and the getting out of bed time, eating liquid diet time, postoperative exhaust time, and total hospital stay were shorter (P<0.05) in the study group. The total complication rate of the study group was lower than that of the control group [28.1% (9/32) vs. 78.1% (25/32), χ²=16.063, P<0.001]. The comprehensive complication index was positively correlated with the total hospital stay (r=0.941, P<0.001) and hospitalization expenses (r=0.958, P<0.001). Conclusion Preliminary results of this study suggest that multimodal analgesia included TAP block is effective in ERAS, and could shorten hospital stay and reduce hospitalization expenses.

Citation： ZHANG Zeling, CHEN Jianzhong, TANG Haiyan, HUANG Xia, YU Dinggang, WANG Qiong. Study of transversus abdominis plane block as part of multimodal analgesia in enhanced recovery after surgery program for patients with hepatic hydatidosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 1042-1047. doi: 10.7507/1007-9424.202111050 Copy

1.	Silva MA, Mirza DF, Bramhall SR, et al. Treatment of hydatid disease of the liver. Evaluation of a UK experience. Dig Surg, 2004, 21(3): 227-233.
2.	何洋, 王文濤. 肝泡型棘球蚴病的手術多模式治療研究進展. 中國普外基礎與臨床雜志, 2021, 28(9): 1243-1248.
3.	王文濤, 楊闖, 嚴律南. 肝泡型包蟲病外科根治性治療的新理念與策略. 中華醫學雜志, 2018, 98(38): 3049-3051.
4.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
5.	陳見中, 喻定剛, 蘭曉蓉, 等. 復雜泡型肝包蟲病MDT討論. 肝膽胰外科雜志, 2020, 32(3): 152-156.
6.	陳哲宇. 復雜肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2017, 24(7): 785-787.
7.	方丹, 陳哲宇. 肝泡狀棘球蚴病的診和治療. 臨床肝膽病雜志, 2017, 33(5): 990-993.
8.	陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.
9.	周東海, 周海霞, 雷軍強, 等. MRI對肝包蟲病的診斷價值. 中國臨床醫學影像雜志, 2006, 17(7): 381-384.
10.	陳見中, 羅斯滿, 喻定剛. 術中經膽管殘端注射亞甲藍稀釋液在肝包蟲術后膽汁漏中應用的隨機對照研究. 中國普外基礎與臨床雜志, 2020, 27(10): 1272-1276.
11.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
12.	張思珍. 青海地區囊型肝包蟲病患者圍手術期快速康復外科理念的應用效果評價. 青海醫藥雜志, 2016, 46(5): 41-43.
13.	中國醫師協會外科醫師分會微創外科醫師委員會. 腹腔鏡肝切除術加速康復外科中國專家共識(2017版). 中國實用外科雜志, 2017, 37(5): 517-524.
14.	Young A, Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol Clin, 2012, 30(1): 91-100.
15.	中華醫學會麻醉學分會. 成人術后疼痛處理專家共識. 臨床麻醉學雜志, 2010, 26(3): 190-196.
16.	賀芳, 甘瑞. ERAS策略下多模式鎮痛在腹腔鏡膽囊切除術中的應用. 新疆醫學, 2019, 49(12): 1212-1214.
17.	Chou LB, Niu EL, Williams AA, et al. Postoperative pain after surgical treatment of ankle fractures: a prospective study. J Am Acad Orthop Surg Glob Res Rev, 2018, 2(9): e021. doi: 10.5435/JAAOSGlobal-D-18-00021.
18.	中國康復技術轉化及發展促進會, 中國研究型醫院學會, 中國醫療保健國際交流促進會, 等. 中國骨科手術加速康復圍手術期疼痛管理指南. 中華骨與關節外科雜志, 2019, 12(12): 929-938.
19.	Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia, 2001, 56(10): 1024-1026.
20.	Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int, 2017, 2017: 8284363. doi: 10.1155/2017/8284363.
21.	Statzer N, Cummings KC 3rd. Transversus abdominis plane blocks. Adv Anesth, 2018, 36(1): 163-180.
22.	Song W, Wang K, Zhang RJ, et al. The enhanced recovery after surgery （ERAS） program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus, 2016, 5: 207. doi: 10.1186/s40064-016-1793-5.
23.	Connor S, Cross A, Sakowska M, et al. Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB (Oxford), 2013, 15(4): 294-301.

1. Silva MA, Mirza DF, Bramhall SR, et al. Treatment of hydatid disease of the liver. Evaluation of a UK experience. Dig Surg, 2004, 21(3): 227-233.
2. 何洋, 王文濤. 肝泡型棘球蚴病的手術多模式治療研究進展. 中國普外基礎與臨床雜志, 2021, 28(9): 1243-1248.
3. 王文濤, 楊闖, 嚴律南. 肝泡型包蟲病外科根治性治療的新理念與策略. 中華醫學雜志, 2018, 98(38): 3049-3051.
4. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
5. 陳見中, 喻定剛, 蘭曉蓉, 等. 復雜泡型肝包蟲病MDT討論. 肝膽胰外科雜志, 2020, 32(3): 152-156.
6. 陳哲宇. 復雜肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2017, 24(7): 785-787.
7. 方丹, 陳哲宇. 肝泡狀棘球蚴病的診和治療. 臨床肝膽病雜志, 2017, 33(5): 990-993.
8. 陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.
9. 周東海, 周海霞, 雷軍強, 等. MRI對肝包蟲病的診斷價值. 中國臨床醫學影像雜志, 2006, 17(7): 381-384.
10. 陳見中, 羅斯滿, 喻定剛. 術中經膽管殘端注射亞甲藍稀釋液在肝包蟲術后膽汁漏中應用的隨機對照研究. 中國普外基礎與臨床雜志, 2020, 27(10): 1272-1276.
11. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
12. 張思珍. 青海地區囊型肝包蟲病患者圍手術期快速康復外科理念的應用效果評價. 青海醫藥雜志, 2016, 46(5): 41-43.
13. 中國醫師協會外科醫師分會微創外科醫師委員會. 腹腔鏡肝切除術加速康復外科中國專家共識(2017版). 中國實用外科雜志, 2017, 37(5): 517-524.
14. Young A, Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol Clin, 2012, 30(1): 91-100.
15. 中華醫學會麻醉學分會. 成人術后疼痛處理專家共識. 臨床麻醉學雜志, 2010, 26(3): 190-196.
16. 賀芳, 甘瑞. ERAS策略下多模式鎮痛在腹腔鏡膽囊切除術中的應用. 新疆醫學, 2019, 49(12): 1212-1214.
17. Chou LB, Niu EL, Williams AA, et al. Postoperative pain after surgical treatment of ankle fractures: a prospective study. J Am Acad Orthop Surg Glob Res Rev, 2018, 2(9): e021. doi: 10.5435/JAAOSGlobal-D-18-00021.
18. 中國康復技術轉化及發展促進會, 中國研究型醫院學會, 中國醫療保健國際交流促進會, 等. 中國骨科手術加速康復圍手術期疼痛管理指南. 中華骨與關節外科雜志, 2019, 12(12): 929-938.
19. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia, 2001, 56(10): 1024-1026.
20. Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int, 2017, 2017: 8284363. doi: 10.1155/2017/8284363.
21. Statzer N, Cummings KC 3rd. Transversus abdominis plane blocks. Adv Anesth, 2018, 36(1): 163-180.
22. Song W, Wang K, Zhang RJ, et al. The enhanced recovery after surgery （ERAS） program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus, 2016, 5: 207. doi: 10.1186/s40064-016-1793-5.
23. Connor S, Cross A, Sakowska M, et al. Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB (Oxford), 2013, 15(4): 294-301.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study of transversus abdominis plane block as part of multimodal analgesia in enhanced recovery after surgery program for patients with hepatic hydatidosis

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