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, 王文涛. 肝泡型棘球蚴病的手术多模式治疗研究进展. 中国普外基础与临床杂志, 2021, 28(9): 1243-1248.
3.	王文涛, 杨闯, 严律南. 肝泡型包虫病外科根治性治疗的新理念与策略. 中华医学杂志, 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.	陈见中, 喻定刚, 兰晓蓉, 等. 复杂泡型肝包虫病MDT讨论. 肝胆胰外科杂志, 2020, 32(3): 152-156.
6.	陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
7.	方丹, 陈哲宇. 肝泡状棘球蚴病的诊和治疗. 临床肝胆病杂志, 2017, 33(5): 990-993.
8.	陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.
9.	周东海, 周海霞, 雷军强, 等. MRI对肝包虫病的诊断价值. 中国临床医学影像杂志, 2006, 17(7): 381-384.
10.	陈见中, 罗斯满, 喻定刚. 术中经胆管残端注射亚甲蓝稀释液在肝包虫术后胆汁漏中应用的随机对照研究. 中国普外基础与临床杂志, 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.	张思珍. 青海地区囊型肝包虫病患者围手术期快速康复外科理念的应用效果评价. 青海医药杂志, 2016, 46(5): 41-43.
13.	中国医师协会外科医师分会微创外科医师委员会. 腹腔镜肝切除术加速康复外科中国专家共识(2017版). 中国实用外科杂志, 2017, 37(5): 517-524.
14.	Young A, Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol Clin, 2012, 30(1): 91-100.
15.	中华医学会麻醉学分会. 成人术后疼痛处理专家共识. 临床麻醉学杂志, 2010, 26(3): 190-196.
16.	贺芳, 甘瑞. ERAS策略下多模式镇痛在腹腔镜胆囊切除术中的应用. 新疆医学, 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.	中国康复技术转化及发展促进会, 中国研究型医院学会, 中国医疗保健国际交流促进会, 等. 中国骨科手术加速康复围手术期疼痛管理指南. 中华骨与关节外科杂志, 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, 王文涛. 肝泡型棘球蚴病的手术多模式治疗研究进展. 中国普外基础与临床杂志, 2021, 28(9): 1243-1248.
3. 王文涛, 杨闯, 严律南. 肝泡型包虫病外科根治性治疗的新理念与策略. 中华医学杂志, 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. 陈见中, 喻定刚, 兰晓蓉, 等. 复杂泡型肝包虫病MDT讨论. 肝胆胰外科杂志, 2020, 32(3): 152-156.
6. 陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
7. 方丹, 陈哲宇. 肝泡状棘球蚴病的诊和治疗. 临床肝胆病杂志, 2017, 33(5): 990-993.
8. 陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.
9. 周东海, 周海霞, 雷军强, 等. MRI对肝包虫病的诊断价值. 中国临床医学影像杂志, 2006, 17(7): 381-384.
10. 陈见中, 罗斯满, 喻定刚. 术中经胆管残端注射亚甲蓝稀释液在肝包虫术后胆汁漏中应用的随机对照研究. 中国普外基础与临床杂志, 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. 张思珍. 青海地区囊型肝包虫病患者围手术期快速康复外科理念的应用效果评价. 青海医药杂志, 2016, 46(5): 41-43.
13. 中国医师协会外科医师分会微创外科医师委员会. 腹腔镜肝切除术加速康复外科中国专家共识(2017版). 中国实用外科杂志, 2017, 37(5): 517-524.
14. Young A, Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol Clin, 2012, 30(1): 91-100.
15. 中华医学会麻醉学分会. 成人术后疼痛处理专家共识. 临床麻醉学杂志, 2010, 26(3): 190-196.
16. 贺芳, 甘瑞. ERAS策略下多模式镇痛在腹腔镜胆囊切除术中的应用. 新疆医学, 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. 中国康复技术转化及发展促进会, 中国研究型医院学会, 中国医疗保健国际交流促进会, 等. 中国骨科手术加速康复围手术期疼痛管理指南. 中华骨与关节外科杂志, 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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