超声引导下腹横肌平面阻滞在肝癌微波消融中的临床应用

Clinical application of ultrasound-guided transversus abdominis plane block in microwave ablation of liver cancer

目的:探讨超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞联合局部麻醉应用于肝癌微波消融(microwave ablation,MWA)的镇痛效果及安全性。方法:回顾并分析2021年11月—2023年6月于江苏省肿瘤医院行超声引导下TAP阻滞联合局部麻醉后行超声引导下MWA的原发性肝癌及转移性肝癌患者。根据消融部位及范围术前行同侧肋缘下+Petit三角双入路TAP阻滞联合局部麻醉,超声引导下TAP平面内注射0.375%罗哌卡因20 mL,使用疼痛数字分级评分法(numerical rating scale,NRS)评估患者术中,术后30 min、1 h、3 h,6 h、12 h、24 h的疼痛程度,观察阻滞有效率、并发症发生情况、术中及术后补救性镇痛药物使用量。结果:纳入的13例原发性肝癌及转移性肝癌患者均1次完成MWA,TAP阻滞联合局部麻醉均成功实施。术中3例(23.1%)患者轻度疼痛(NRS)无干预;1例(7.7%)患者中度疼痛,肌注镇痛药物完成消融治疗。术后3例(23.1%)患者出现轻度疼痛,未予干预,均于6 h内自然缓解。术中及术后均无TAP阻滞相关并发症发生。所有患者消融治疗后24 h对TAP阻滞联合局部麻醉镇痛效果满意度100.0%。结论:超声引导下TAP阻滞联合局部麻醉在肝癌MWA中应用安全有效,拓宽了肝癌MWA应用范围。

Objective:To investigate the analgesic effect and safety of ultrasound-guided transversus abdominis plane(TAP)block combined with local anesthesia for microwave ablation(MWA)of liver cancer.Methods:Patients with primary liver cancer and metastatic liver cancer who underwent ultrasound-guided MWA after ultrasound-guided TAP block combined with local anesthesia in Jiangsu Cancer Hospital from November 2021 to June 2023 were retrospectively analyzed.According to the ablation site and range of preoperative ipsilateral subcostal margin+Petit triangle dual access TAP block combined with local anesthesia,and ultrasound-guided TAP in-plane injection of 0.375%ropivacaine 20 mL,and patients were evaluated by using numerical rating scale(NRS)to assess the pain level in the intraoperative period,and the postoperative period of 30 min,1 h,3 h,6 h,12 h and 24 h.The pain level of the block was observed.The pain level of the patients was evaluated using the numerical rating scale(NRS)during the operation,30 min,1 h,3 h,6 h,12 h and 24 h after the operation,and the block efficiency,complication occurrence,and the amount of remedial analgesic used during and after the operation were observed.Results:All 13 patients with primary liver cancer and metastatic liver cancer underwent MWA in 1 session,and TAP block combined with local anesthesia was successfully performed.Three(23.1%)patients had mild pain(NRS)without intervention;one(7.7%)patient had moderate pain,and the ablation was completed with intramuscular analgesic drugs.Postoperatively,3(23.1%)patients had mild pain without intervention,all of which resolved spontaneously within 6 h.There were no intraoperative or postoperative complications related to TAP block.All patients were 100.0%satisfied with the effect of TAP block combined with local anesthesia for 24 h after ablation.Conclusion:Ultrasoundguided TAP block combined with local anesthesia is safe and effective in MWA of liver cancer,broadening the application range of MWA of liver cancer.