■由于手术技术和病例复杂性,食管切除术传统上具有高水平的围手术期发病率和死亡率。虽然胸段硬膜外镇痛(TEA)被认为是食管切除术后术后镇痛的一线,可能会出现与交感神经切除术和活动障碍有关的并发症。此外,研究表明,食管切除术后早期拔管可改善术后结局.我们的目的是描述与TEA分离时,腹横肌平面(TAP)阻滞对食管切除术后拔管率的影响。
■这是一个病例系列,由42例患者组成,这些患者在2019年至2022年之间接受了经食管食管切除术,接受了无TEA的TAP阻滞。感兴趣的主要结果是手术室内拔管率(OR)和再插管率。次要结果包括:重症监护病房(ICU)和住院时间(LOS),阿片类止痛药的使用,术后低血压,液体管理,术后疼痛评分,吻合口漏的发展,30天的重新接纳。
■手术平均年龄为63岁,其中97.6%的患者表现为美国麻醉学会(ASA)的III级或IV级身体状况。术后立即拔管的患者有34例(81%)。9名患者(21.4%)在住院期间接受了再插管。术后只有7例患者(16.7%)需要血管加压药。ICU中的中位LOS为5天,医院中为10天。在立即拔管的基础上,发现单独的TAP阻滞等同于具有额外区域阻滞(TAP)的TAP。再插管,ICU和医院LOS,并报告术后疼痛。
■这项研究的结果表明,使用TAP阻滞可以立即拔管,同时限制术后低血压和液体给药。尽管本研究人群的合并症负担升高,但仍表明了这一点。总的来说,这项研究支持TAP阻滞作为一种可能的替代方法用于经口食管切除术患者的原发性镇痛.
■本研究包括回顾性登记的参与者。IRB#037。HPB.2018。R.
UNASSIGNED: Esophagectomy traditionally has high levels of perioperative morbidity and mortality due to surgical techniques and
case complexity. While thoracic
epidural analgesia (TEA) is considered first-line for postoperative analgesia after esophagectomy, complications can arise related to its sympathectomy and mobility impairment. Additionally, it has been shown that postoperative outcomes are improved with early extubation following esophagectomy. Our aim is to describe the impact of transversus abdominis plane (TAP) blocks on extubation rates following esophagectomy when uncoupled from TEA.
UNASSIGNED: This is a
case series of 42 patients who underwent trans-hiatal esophagectomy between 2019 and 2022 who received a TAP block without TEA. The primary outcomes of interest were the rates of extubation within the operating room (OR) and reintubation. Secondary outcomes included: intensive care unit (ICU) and hospital length of stay (LOS), opioid pain medication use, post-operative hypotension, fluid administration, postoperative pain scores, development of anastomotic leak, and 30-day readmission.
UNASSIGNED: The mean age at operation was 63 years and 97.6% of patients were represented by American Society of Anesthesia (ASA) physical status class III or IV. Thirty-four (81%) patients immediately extubated postoperatively. Nine patients (21.4%) underwent reintubation during their hospital course. Only seven patients (16.7%) required vasopressors postoperatively. The median LOS was five days in the ICU and 10 days in the hospital. TAP block alone was found to be equivalent to TAP with additional regional blocks (TAP+) on the basis of immediate extubation, reintubation, ICU and hospital LOS, and reported postoperative pain.
UNASSIGNED: The results of this study demonstrated immediate extubation is possible using TAP blocks while limiting post-operative hypotension and fluid administration. This was shown despite the elevated comorbidity burden of this study\'s population. Overall, this study supports the use of TAP blocks as a possible alternative for primary analgesia in patients undergoing trans-hiatal esophagectomy.
UNASSIGNED: This study includes participants who were retrospectively registered. IRB# 037.HPB.2018.R.