ASSESSMENT OF THE EFFICIENCY OF ANALGETIC ACTION OF LAPAROSCOPICALLY ASSISTED TAP BLOCK AS A COMPONENT OF PERIOPERATIVE MULTIMODAL ANALGESIA PLAN IN OBESE PATIENTS UNDERGOING METABOLIC SURGERY.

OBJECTIVE: The aim: To assess the effectiveness and feasibility of laparoscopically assisted TAP block utilization in the system of multimodal analgesia by comparing the severity of pain and associated postoperative recovery indicators in obese patients after laparoscopic sleeve gastrectomy. PATIENTS AND METHODS: Materials and methods: The retrospective study included 39 patients, who underwent metabolic surgery from 2013-2022. All patients were divided into 2 groups depending on the chosen perioperative analgesia protocol. Group 1 included 19 patients who prior to skin incision a local infiltration of the trocar puncture areas of the abdominal wall. Group 2 included 20 patients, whom in addition to the above-described anaesthesia procedure after completion of the main stage of surgery, a laparoscopically assisted bilateral subcostal TAP block was additionally performed. RESULTS: Results: The need to use opioid analgesics in the rescue analgesia mode arose in 17.6% (3/17) of patients of the first group, and 5% (1/20) of patients in the second group Average duration of postoperative hospitalization in group 1 was 7.2±1.1 days, and in group 2 it was 6.2±1.4 days (P <0.05). CONCLUSION: Conclusions: Subcostal TAP block in obese patients is a safe and effective method of regional anaesthesia. Further study of this option of regional anaesthesia is required in order to be able to form clearer recommendations for its routine use in clinical practice.

IMPLEMENTATION OF ENHANCED RECOVERY AFTER SURGERY PROTOCOL FOR METABOLIC SURGERY PATIENTS (LITERATURE REVIEW).

The article reviews the literature highlighting modern views on the issues of postoperative rehabilitation of patients after metabolic surgical interventions. The concept of accelerated postoperative recovery of patients is presented as a single integral system of principles, means and methods of multidisciplinary work in the perioperative period aimed at reducing the time of hospitalization of patients and reducing the financial costs of the healthcare system. The separate components of the protocol of accelerated postoperative recovery from the standpoint of evidence-based medicine are analyzed, an emphasis is made on its specificity in metabolic surgery. The key role of laparoscopic access at the present stage of development of metabolic surgery is emphasized. Specific risk factors have been identified in patients with obesity, type 2 diabetes mellitus and metabolic syndrome, which can affect the effectiveness and safety of surgical treatment, especially in conditions of early discharge from the hospital. Attention is focused on the extremely important, but still controversial positions of the protocol, requiring further research to form a better evidence base and clear practical recommendations. The promising directions of scientific research for improving both the system of accelerated postoperative recovery as a whole and its individual elements are demonstrated. Electronic databases of Scopus and PubMed were searched using keyword searches. The analysis of the literature has shown the feasibility of introducing, systemic use and further improvement of the protocol for accelerated postoperative recovery in metabolic surgery.