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2025 03 v.28 213-216
神经阻滞技术在减重手术中的临床应用进展
基金项目(Foundation):
邮箱(Email): wangzhou@qiluhospital.com;
DOI:
中文作者单位:

山东大学齐鲁医院麻醉科;

摘要(Abstract):

接受减重手术治疗的肥胖患者人数在全球范围内呈现递增趋势,有关术后如何快速康复、如何提高恢复质量的问题也逐渐被临床医师和患者重视。神经阻滞技术作为一种与加速康复外科相关的干预方式,在减重手术中的优势亟待临床医师去不断发掘。目前可以应用于减重手术中的神经阻滞技术包含竖脊肌平面阻滞、腹横肌平面阻滞、腰方肌阻滞和椎旁阻滞等多种类型。从操作方法、阻滞效果及患者收益等方面对减重手术中涉及到的神经阻滞技术进行综述,为麻醉科医师在实践工作中的应用提供有临床价值的参考意见。

关键词(KeyWords): 神经阻滞;减重手术;术后恢复
参考文献

[1] Boutari C, Mantzoros C. A 2022 update on the epidemiology of obesity and a call to action:as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on[J]. Metabolism, 2022, 133:155217. DOI:10.1016/j. metabol.2022.155217.

[2] Fareed A, Ghanem L, Vaid R, et al. Charting new territories in obesity management-traditional techniques to tirzepatide[J]. Endocr Pract, 2025, 31(1):102-113. DOI:10.1016/j.eprac.2024.09.004.

[3] Andersen L, Werner M, Rosenberg J. Analgesic treatment in laparoscopic gastric bypass surgery:a systematic review of randomized trials[J]. Obes Surg, 2014, 24(3):462-70. DOI:10.1007/s11695-013-1172-z.

[4]王迪,丁颖,纪木火,等.超声引导下区域神经阻滞用于腹腔镜减重手术后镇痛的研究进展[J].临床麻醉学杂志,2024,40(7):746-750. DOI:10.12089/jca.2024.07.014.

[5]田志帅,贾明洋,陈帅帅,等.加速康复外科对腹腔镜袖状胃切除术后恶心呕吐的影响[J].中国现代普通外科进展,2024,27(11):899-902. DOI:10.3969/j.issn.1009-9905.2024.11.013.

[6] Stenberg E, Dos Reis Falc?o LF, O’Kane M, et al. Guidelines for perioperative care in bariatric surgery:enhanced recovery after surgery(ERAS)society recommendations:a 2021 update[J]. World J Surg, 2022, 46(4):729-751. DOI:10.1007/s00268-021-06394-9.

[7] Kot P, Rodriguez P, Granell M, et al. The erector spinae plane block:a narrative review[J]. Korean J Anesthesiol, 2019, 72(3):209-220.DOI:10.4097/kja.d.19.00012.

[8] Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block:a novel analgesic technique in thoracic neuropathic pain[J].Reg Anesth Pain Med, 2016, 41(5):621-627. DOI:10.1097/AAP.0000000000000451.

[9] Pawa A, King C, Thang C, et al. Erector spinae plane block:the ultimate “plan A” block[J]. Br J Anaesth, 2023, 130(5):497-502. DOI:10.1016/j.bja.2023.01.012.

[10] Sun L, Mu J, Yu L, et al. Continuous erector spinae plane block for postoperative analgesia in elderly patients after thoracoscopic lobectomy[J]. J Perianesth Nurs, 2024, 39(5):887-891. DOI:10.1016/j.jopan.2024.01.001.

[11] Zhang J, Zhang F, Zhang H, et al. Effect of ropivacaine combined with nalbuphine in erector spinae plane block on postoperative analgesia in lumbar trauma surgery:a single-center randomized controlled trial[J]. J Pain Res, 2025, 3(18):11-19. DOI:10.2147/JPR.S493518.

[12] Jinaworn P, Pannangpetch P, Bunanantanasan K et al. Efficacy of erector spinae plane block on postoperative analgesia for patients undergoing metabolic bariatric surgery:a randomized controlled trial. Obes Surg, 2024, 34(11):4211-4219. DOI:10.1007/s11695-024-07515-8.

[13] Nair AS, Rangaiah M, Dudhedia U, et al. Analgesic efficacy and outcomes of ultrasound-guided erector spinae plane block in patients undergoing bariatric and metabolic surgeries:a systematic review[J].J Med Ultrasound, 2023, 31(3):178-187. DOI:10.4103/jmu.jmu_112_22.

[14] Mostafa S, Abdelghany M, Elyazed M. Ultrasound-guided erector spinae plane block in patients undergoing laparoscopic bariatric surgery:a prospective randomized controlled trial[J]. Pain Pract, 2021,21(4):445-453. DOI:10.1111/papr.12975.

[15] Karaveli A, Kaplan S, Kavakli A, et al. The effect of ultrasoundguided erector spinae plane block on postoperative opioid consumption and respiratory recovery in laparoscopic sleeve gastrectomy:a randomized controlled study[J]. Obes Surg, 2025, 35(1):112-121.DOI:10.1007/s11695-024-07576-9.

[16] Zengin S, Ergun M, Gunal O. Effect of ultrasound-guided erector spinae plane block on postoperative pain and intraoperative opioid consumption in bariatric surgery[J]. Obes Surg, 2021, 31(12):5176-5182. DOI:10.1007/s11695-021-05681-7.

[17] Toprak H, Ba?aran B, Toprak S, et al. Efficacy of the erector spinae plane block for quality of recovery in bariatric surgery:a randomized controlled trial[J]. Obes Surg, 2023, 33(9):2640-2651. DOI:10.1007/s11695-023-06748-3.

[18] Wang Y, Zuo S, Ma Y, et al. Effect of ultrasound-guided erector spinae plane block on recovery after laparoscopic sleeve gastrectomy in patients with obesity:a randomized controlled trial[J]. Clin Ther,2023, 45(9):894-900. DOI:10.1016/j.clinthera.2023.07.010.

[19] Rafi A. Abdominal field block:a new approach via the lumbar triangle[J]. Anaesthesia, 2001, 56(10):1024-1026. DOI:10.1046/j.1365-2044.2001.02279-40.x.

[20] O'Donnell B, McDonnell J, McShane A. The transversus abdominis plane(TAP)block in open retropubic prostatectomy[J]. Reg Anesth Pain Med, 2006, 31(1):91. DOI:10.1016/j.rapm.2005.10.006.

[21] Hebbard P, Fujiwara Y, Shibata Y, et al. Ultrasound-guided transversus abdominis plane(TAP)block[J]. Anaesth Intensive Care,2007, 35(4):616-617.

[22] Lee T, Barrington M, Tran T, et al. Comparison of extent of sensory block following posterior and subcostal approaches to ultrasoundguided transversus abdominis plane block[J]. Anaesth Intensive Care, 2010, 38(3):452-460. DOI:10.1177/0310057X1003800307.

[23] Xiao H, Du Y, Li G, et al. Nerve block techniques utilized in postbariatric surgery:a narrative review[J]. BMC Surg, 2025, 25(1):74.DOI:10.1186/s12893-025-02801-3.

[24] Tsai H, Yoshida T, Chuang T, et al. Transversus abdominis plane block:an updated review of anatomy and techniques[J]. Biomed Res Int, 2017, 2017:8284363. DOI:10.1155/2017/8284363.

[25] Tran D, Bravo D, Leurcharusmee P, et al. Transversus abdominis plane block:reply[J]. Anesthesiology, 2020, 132(6):1599. DOI:10.1097/ALN.0000000000003243.

[26]赵再荣,钱金桥.超声引导下腹横肌平面阻滞在腹腔镜减重手术患者术后镇痛中的应用效果分析[J].中国社区医师,2024,40(14):76-78. DOI:10.3969/j.issn.1007-614x.2024.14.026.

[27] Abdelhamid B, Khaled D, Mansour M, et al. Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy:a randomized controlled trial[J]. Minerva Anestesiol, 2020, 86(8):816-826. DOI:10.23736/S0375-9393.20.14064-1.

[28] Elshazly M, El-Halafawy Y, Mohamed D, et al. Feasibility and efficacy of erector spinae plane block versus transversus abdominis plane block in laparoscopic bariatric surgery:a randomized comparative trial[J]. Korean J Anesthesiol, 2022, 75(6):502-509.DOI:10.4097/kja.22169.

[29] Filardi K, Filardi R, Wegner B, et al. Ultrasound-guided transversus abdominis plane block as an effective path to reduce opioid consumption after laparoscopic bariatric surgery:a systematic review and meta-analysis of randomized controlled trials[J]. Obes Surg,2024, 34(11):4244-4254. DOI:10.1007/s11695-024-07532-7.

[30] Chaudhuri S, Goyal S. Ultrasound-guided transversus abdominis plane block:A technically easier analgesic option in obese compared to epidural[J]. Anesth Essays Res, 2012, 6(2):226-228.DOI:10.4103/0259-1162.108344.

[31] Ruiz-Tovar J, Albrecht E, Macfarlane A, et al. The TAP block in obese patients:pros and cons[J]. Minerva Anestesiol, 2019, 85(9):1024-1031. DOI:10.23736/S0375-9393.19.13545-6.

[32] Tanggaard K, Gronlund C, Nielsen M, et al. Anterior quadratus lumborum blocks for postoperative pain treatment following intraabdominal surgery:A systematic review with meta-analyses and trial sequential analyses[J]. Acta Anaesthesiol Scand, 2025, 69(1):e14526. DOI:10.1111/aas.14526.

[33] Ashoor T, Jalal A, Said A, et al. Ultrasound-guided techniques for postoperative analgesia in patients undergoing laparoscopic sleeve gastrectomy:erector spinae plane block vs. quadratus lumborum block[J]. Pain Physician, 2023, 26(3):245-256.

[34] Zhao X, Xue Q, Dong L, et al. Effects of peripheral neural blocks in laparoscopic sleeve gastrectomy:a pilot study on cognitive functions in severe obese patients[J]. Obes Surg, 2023, 33(1):129-138. DOI:10.1007/s11695-022-06319-y.

[35] Xue Q, Chu Z, Zhu J, et al. Analgesic efficacy of transverse abdominis plane block and quadratus lumborum block in laparoscopic sleeve gastrectomy:a randomized double-blinded clinical trial[J].Pain Ther, 2022, 11(2):613-626. DOI:10.1007/s40122-022-00373-1.

[36] Li H, Ma D, Liu Y, et al. A transverse approach for ultrasoundguided anterior quadratus lumborum block at the lateral supraarcuate ligament[J]. Anaesthesia, 2020, 75(10):1400-1401. DOI:10.1111/anae.15058.

[37]仲明杰,朱伟,从文博,等.超声引导下外侧弓状韧带上腰方肌前侧阻滞在减重手术中的应用[J].中国临床研究,2024,37(8):1197-1201. DOI:10.13429/j.cnki.cjcr.2024.08.011.

[38] Batra R, Krishnan K, Agarwal A, et al. Paravertebral block[J]. J Anaesthesiol Clin Pharmacol, 2011, 27(1):5-11.

[39] Yang G, Wang P, Yin Y, et al. Erector spinae plane block versus paravertebral block on postoperative quality of recovery in obese patients undergoing laparoscopic sleeve gastrectomy:a randomized controlled trial[J]. PeerJ, 2024, 28(12):e17431. DOI:10.7717/peerj.17431.

[40] Schott N, Chamu J, Ahmed N, et al. Perioperative truncal peripheral nerve blocks for bariatric surgery:an opioid reduction strategy[J].Surg Obes Relat Dis, 2023, 19(8):851-857. DOI:10.1016/j.soard.2023.01.014.

[41]赵伟新,王朋飞,王琰.超声引导下胸椎旁阻滞联合全身麻醉对减重手术患者的影响[J].河南医学研究,2024,33(8):1392-1395. DOI:10.3969/j.issn.1004-437X.2024.08.013.

[42] Abdulsalam A, Mistry T, Kumar M, et al. Ultrasound-guided modified blocking the branches of intercostal nerves in the middle axillary line(BRILMA)block as the sole anaesthetic technique for incision and drainage of truncal abscess in a high-risk patient[J]. Indian J Anaesth, 2020, 64(8):733-735. DOI:10.4103/ija.IJA_341_20.

[43] Kara Y, Ital I, Ertekin S, et al. Ultrasonography guided modified BRILMA(blocking the cutaneous branches of intercostal nerves in the middle axillary line)block in bariatric surgery[J]. J Laparoendosc Adv Surg Tech A, 2023, 33(12):1141-1145. DOI:10.1089/lap.2023.0223.

[44] Co?arcan S, Yavuz Y, Do?an A, et al. Can postoperative pain be prevented in bariatric surgery? efficacy and usability of fascial plane blocks:a retrospective clinical study[J]. Obes Surg, 2022, 32(9):2921-2929. DOI:10.1007/s11695-022-06184-9.

[45] Oliveira E, Lima R, Sakata R, et al. Modified thoracoabdominal nerve block through the perichondral approach(M-TAPA)in laparoscopic sleeve gastroplasty:a case series[J]. Obes Surg, 2022, 32(1):197-201. DOI:10.1007/s11695-021-05612-6.

[46] Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA)provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy[J]. J Clin Anesth, 2020, 59:44-45. DOI:10.1016/j.jclinane.2019.06.020.

[47]赵聪,尹泓,蔡敏,等.改良经肋软骨膜入路胸腹神经阻滞与腹横肌平面阻滞用于腹腔镜袖状胃切除术的比较[J].临床麻醉学杂志,2022,38(6):569-573. DOI:10.12089/jca.2022.06.002.

[48] Sun J, Zhang E, Chen X, et al. Ultrasound-guided superior laryngeal nerve block facilitates anesthesia management in bariatric surgery[J]. J Emerg Med, 2022, 62(4):e85-e87. DOI:10.1016/j. jemermed.2021.12.019.

基本信息:

DOI:

中图分类号:R614

引用信息:

[1]仲美儒,王舟.神经阻滞技术在减重手术中的临床应用进展[J].中国现代普通外科进展,2025,28(03):213-216.

基金信息:

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