Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial

Hai-Ming Huang,Yuan Yuan,Lei Zhang,Lin-Mei Zhu,Xi-Jiu Ye,Wen-Shuai Zhao,Xue-Ying Yang,Rui-Xia Chen,Fu-Ding Lu,Jun Cao,Jian-Wei Luo

doi:10.1038/s41598-020-71477-x

Hai-Ming Huang, Yuan Yuan + Show 9 more

Open Access

https://doi.org/10.1038/s41598-020-71477-x

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Abstract

The incidence and mortality of primary liver cancer are very high and resection of tumor is the most crucial treatment for it. We aimed to assess the efficacy and safety of combined use of transversus abdominis plane (TAP) block and laryngeal mask airway (LMA) during implementing Enhanced Recovery After Surgery (ERAS) programs for patients with primary liver cancer. This was a prospective, evaluator-blinded, randomized, controlled parallel-arm trial. A total of 96 patients were enrolled (48 in each group). Patients in the control group received general anesthesia with endotracheal intubation, while patients in the TAP + LMA group received general anesthesia with LMA and an ultrasound-guided subcostal TAP block. The primary end-point was postoperative time of readiness for discharge. The secondary end-points were postoperative pain intensity, time to first flatus, quality of recovery (QoR), complications and overall medical cost. Postoperative time of readiness for discharge in the TAP + LMA group [7 (5–11) days] was shorter than that of the control group [8 (5–13) days, P = 0.004]. The postoperative apioid requirement and time to first flatus was lower in the TAP + LMA group [(102.8 ± 12.4) µg, (32.7 ± 5.8) h, respectively] than the control group [(135.7 ± 20.1) µg, P = 0.000; (47.2 ± 7.6) h, P = 0.000; respectively]. The QoR scores were significantly higher in the TAP + LMA group than the control group. The total cost for treatment in the TAP + LMA group [(66,608.4 ± 6,268.4) CNY] was lower than that of the control group [(84,434.0 ± 9,436.2) CNY, P = 0.000]. There was no difference in complications between these two groups. The combined usage of a TAP block and LMA is a simple, safe anesthesia method during implementing ERAS programs for patients with primary liver cancer. It can alleviate surgical stress, accelerate recovery and reduce medical cost.

Highlights

ETI Endotracheal intubation endotracheal tube (ETT) Endotracheal tube computerized tomography (CT) Computerized tomography magnetic resonance imaging (MRI) Magnetic resonance imaging intensive care unit (ICU) Intensive care unit NI Narcotrend Index Central Venous Pressure (CVP) Central venous pressure patient-controlled intravenous analgesia (PCIA) Patient-controlled intravenous analgesia post-anesthesia care unit (PACU) Post-anesthesia care unit numerical rating scale (NRS) Numerical rating scale quality of recovery (QoR) Quality of recovery Patient-reported Quality (PRO) Patient-reported quality Doctor-reported Quality (DRO) Doctor-reported quality
Peripheral nerve block techniques that can be used for open liver surgery include thoracic paravertebral block (TPVB), intercostal nerve block, quadratus lumborum block (QLB), transversus abdominis plane (TAP) block and rectus sheath block
We hypothesized that the combined usage of a TAP block and laryngeal mask airway (LMA) could be safely performed for patients with primary liver cancer during implementing Enhanced Recovery After Surgery (ERAS) programs and reduce the postoperative time of readiness for discharge

Summary

Introduction

ETI Endotracheal intubation ETT Endotracheal tube CT Computerized tomography MRI Magnetic resonance imaging ICU Intensive care unit NI Narcotrend Index CVP Central venous pressure PCIA Patient-controlled intravenous analgesia PACU Post-anesthesia care unit NRS Numerical rating scale QoR Quality of recovery PRO Patient-reported quality DRO Doctor-reported quality. Regional blockade combined with general anesthesia is recommended strongly as the optimal anesthetic protocol for open abdominal surgery with an ERAS p rogram[6,7]. Local wound infiltration is not the preferred regional blockade for liver surgery, because of short analgesic time, susceptibility to systemic poisoning from local anesthetic and adverse effect on wound healing. The rectus sheath block only has a blocking effect on the nerves innervating the antetior abdominal wall, so it is not suitable for open liver surgery when used alone. We hypothesized that the combined usage of a TAP block and LMA could be safely performed for patients with primary liver cancer during implementing ERAS programs and reduce the postoperative time of readiness for discharge

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