| [Objective and background]The incidence of obesity is increasing year by year around the world,and it is currently estimated that the incidence is more than 60%[1].The incidence of overweight and obesity among adults in China is 46%,and it is increasing year by year.Obesity and its comorbidities have a serious impact on people’s quality of life and mental state,and it also brings a huge medical burden to the society.Obesity is known as immortal cancer.Bariatric surgery has a great effect on the treatment of obesity,can improve the quality of life,reduce the occurrence of various obesity complications,and can reduce the long-term mortality rate and total medical expenses of obese patients.Despite the laparoscopic approach,postoperative pain remains an important factor in patients’ recovery after surgery,therefore,analgesic drugs are widely used after surgery.Obesity-related complications can have a magnifying effect on opioid-related complications,which is not conducive to postoperative recovery.In order to reduce the complications related to analgesic drugs in obese patients,now multimodal analgesia is promoted.The transversus abdominis plane(TAP)block is a good technique of regional anesthesia,targeting the sensory nerves T6-L1 of the anterior lateral abdominal wall.And it has achieved good analgesic effects in abdominal operations such as cholecystectomy,cesarean section,and colorectal,but there are few studies on its application in bariatric surgery.Our goal is to observe the effect of the transversus abdominis plane block under ultrasound to reduce the consumption of analgesics after bariatric surgery,evaluate its safety and reliability to further optimize the postoperative analgesia strategy for bariatric surgery patients.[Methods]This study was approved by the hospital ethic committee,we selected 150 patients who underwent laparoscopic sleeve gastrectomy(LSG)at Qilu Hospital of Shandong University between January 1,2019 and December 31,2020.Randomly divided into two groups:all patients received general anesthesia combined with ultrasound-guided bilateral transverse abdominis plane in group T(N=64).The C group(n=86)only received general anesthesia.According to the patients’ BMI,they were divided into three subgroups:B1 group 30.00～39.99 kg/m2,B2 group 40.00～49.99 kg/m2,and B3 group≥50 kg/m2.Observation indicators are the use of postoperative analgesic drugs(opioids and non-steroidal analgesics),the use of antiemetic drugs,and the postoperative recovery(liquid diet time,time to pull out the abdominal drainage tube,etc.),occurrence of adverse reactions after operation and length of hospital stay.P<0.05 was statistically different.[Results]1.The amount of opioids and non-steroidal analgesics are required for group T obviously lower than that in group C(P<0.05);group T needed analgesics was significantly lower than group C during t1 and tH(P<0.05).In group B1 and B2,the number of opioids and non-steroidal analgesics needed in group T was less than that in group C(P<0.05),and the amount of patients who needed analgesics in t1 and tH in group T was less than that in group C(P<0.05).2.There was significant difference in the use of opioids and non-steroidal analgesics among the three subgroups of group T in t1 time and tH time(P<0.05);Statistical significance differences in the use of analgesics in t1 and tH time among the three subgroups of group T(P<0.05);There was significant difference in the use of analgesics in t1 and tH time among the three subgroups of group T(P<0.05).The Bonferroni method was used to adjust the p-value level during pairwise comparison.During t1 and tH,the application of opioids in group T in group B2 was better than that in group B3,and the application of non-steroidal drugs in group B1 and B2 was better than group B3.During t1 and tH,the application of analgesics in group B1 and group B2 in group T was better than that in group B3.3.The number of patients who needed antiemetic drugs in the group T obviously was less than that in group C(P<0.05).In group B2,the removal of abdominal drainage tube in group T was better than that in group C(P<0.05),and the need for antiemetic drugs in group T was better than that in group C(P<0.05).[Conclusion]Ultrasound-guided transverse abdominis plane block is an effective means of postoperative pain management in obese patients with bariatric surgery,and can be used as a part of multimodal analgesia.Our research demonstates that transverse abdominis plane block under ultrasound-guided can reduce the use of postoperative analgesics and antiemetic drugs in obese patients with bariatric surgery. |
