超声引导下腹横平面阻滞对腹腔镜肾输尿管切除患者术后镇痛效果的随机对照双盲研究

The effects of ultrasound-guided transversus abdominis plane block on analgesia in the patients undergoing laparoscopic nephroureterectomy:a randomized controlled double-blinded trial

目的评价术前超声引导下腹横平面(TAP)阻滞对腹腔镜肾输尿管切除患者术后镇痛效果和恶心呕吐(PONV)发生率的影响。方法随机对照双盲研究,将拟行腹腔镜肾输尿管切除的患者随机分为TAP组和假阻滞组(对照组)。TAP组患者在术前接受超声引导下TAP阻滞,注射0.75%罗哌卡因25 ml;对照组注射生理盐水25 ml。所有患者接受全麻下腹腔镜肾输尿管切除手术,术毕启动静脉吗啡患者自控(PCA)泵。记录术后12 h内疼痛视觉模拟评分(VAS),记录术中芬太尼、术后吗啡累计用量以及术后PONV发生率。结果 40例患者纳入本研究,每组20例。TAP组在术后2、4、6、12 h的VAS评分均低于对照组(P<0.05);TAP组患者首次使用吗啡补救镇痛的时间晚于对照组[(145±36)min vs.(64±35)min,P<0.05],TAP组术后48 h吗啡累计用量低于对照组[(22.0±10.5)mg vs.(60.0±19.3)mg,P<0.05],且PONV发生率低于对照组(20.0%vs.55.0%,P<0.05)。结论术前超声引导下TAP阻滞,对于腹腔镜肾输尿管切除术能产生良好的术后镇痛效果,降低阿片类用量和PONV发生率。

Objective To evaluate the effects of ultrasound-guided transversus abdonimis plane （TAP） block on an- algesia and postoperative nausea and vomiting （PONV） in patients undergoing laparoscopic nephroureterectomy. Meth- ods A randomized controlled double-blinded trial was conducted. The patients scheduled for laparoscopic nephroureterec- tomy were randomly assigned into the group TAP and the control group. The patients in the group TAP received ultra- sound-guided TAP block 30 min before surgery, with an injection of 0.75% ropivocaine 25 ml. The patients in the control group received sham TAP block, with an injection of normal saline 25 ml. All the patients received general anesthesia and laparoscopic nephroureterectomy in the operating room （OR）, and patient-controlled analgesic （PCA） IV morphine pump were started at the end of surgery. Patients were assessed for postoperative pain score with visual analogue scale （VAS）. In- traoperative fentanyI consumption, postoperative morphine consumption, and incidence of PONV 48 h after surgery were recorded. Patients were followed-up for any complications during hospital stay. Results Forty patients were enrolled in the study, 20 patients were in each group. Compared to the control group, the VAS scores in group TAP patients signifi- cantly decreased in postoperative 2,4,6, 12 h （P 〈 0.05）, and the consumption of postoperative morphine in in the patients of group TAP was less[（22.0± 10.5）mg vs. （60.0± 19.3）mg, P 〈 0.05]. The first time of rescue morphine was later in the group TAP than in the control group [（ 145±36）min vs. （64±35）min, P 〈 0.05], and the incidence of PONV was lower in the group TAP than in the control group （20.0% vs. 55.0%, P 〈 0.05）. Conclusion Ultrasound-guided TAP block results in better postoperative analgesic effects, reduces opioids consumption and less PONV incidence in patients who are under- going laparoscopic nephroureterectomy.