超声引导腹横肌平面阻滞在妇科腹腔镜手术后镇痛中的应用

Postoperative analgesic effect of ultrasound-guided transversus abdominis plane block after gynecologic laparoscopic surgery

目的观察超声引导下腹横肌平面阻滞(TAPB)在妇科腹腔镜术后镇痛中的效果。方法 60例全凭静脉麻醉下行妇科腹腔镜手术的患者,随机分为对照组、常规治疗组及TAPB组,每组20例患者。术毕对照组不使用镇痛治疗,常规治疗组术后使用静脉镇痛泵,TAPB组仅使用腹横肌平面阻滞技术进行镇痛治疗。比较三组患者术后4 h、8 h、12 h和24 h静态、动态疼痛视觉模拟评分(VAS)及恶心、呕吐和腹横肌平面阻滞相关不良反应的发生情况。结果术后4 h、8 h、12 h和24 h静态VAS对照组为(2.70±1.41)分、(3.05±1.28)分、(3.40±1.46)分和(3.45±1.47)分,常规治疗组为(1.60±1.11)分、(1.65±1.19)分、(1.70±1.27)分和(1.70±1.38)分,TAPB组为(1.70±1.27)分、(1.60±1.20)分、(1.55±1.20)分和(1.75±1.41)分,常规治疗组及TAPB组与对照组比较差异有统计学意义(P<0.05),常规治疗组与TAPB组比较差异无统计学意义(P>0.05);术后4 h、8 h、12 h和24 h动态VAS对照组为(4.65±1.53)分、(4.90±1.64)分、(5.30±1.62)分和(5.20±1.81)分,常规治疗组为(3.05±1.60)分、(2.95±1.63)分、(3.35±1.59)分和(3.50±1.69)分,TAPB组为(3.00±1.64)分、(3.10±1.43)分、(3.30±1.62)分和(3.60±1.66)分,常规治疗组及TAPB组与对照组比较差异有统计学意义(P<0.05),常规治疗组与TAPB组比较差异无统计学意义(P>0.05)。术后恶心、呕吐发生率对照组为65.0%,常规治疗组为60.0%,TAPB组为55.0%,三组比较差异无统计学意义(P>0.05)。TAPB组未见腹横肌平面阻滞穿刺引起的不良反应。结论超声引导下腹横肌平面阻滞用于妇科腹腔镜术后镇痛效果确切,对恶心、呕吐有减少趋势,且不增加其他不良反应,有利于术后康复。超声引导下腹横肌平面阻滞可以作为多模式术后镇痛的一种选择,为妇科腹腔镜手术提供满意的术后镇痛。

Objective To observe the postoperative analgesic effect of ultrasound-guided transversus abdominis plane block after gynecologic laparoscopic surgery. Methods Sixty patients with gynecologic laparoscopic surgery under total intravenous anesthesia were selected,and they were randomly divided into control group,routine therapeutic group and transversus abdominis plane block（ TAPB） group with 20 cases in each group. Patients in control group had no analgesic therapy after gynecologic laparoscopic surgery,while patients in routine therapeutic group received controlled intravenous analgesia（ PCIA） and patients in TAPB group received ultrasound-guided transversal abdominal plane block. The resting and moving visual analogue scores（ VAS） at 4,8,12 and 24 hour after surgery were compared among these 3 groups. Nausea and vomiting after surgery and the side effects of transversal abdominal plane block were recorded. Results The resting VAS scores at 4,8,12 and 24 hour after surgery in control group were 2. 70 ± 1. 41,3. 05 ± 1. 28,3. 40 ± 1. 46 and 3. 45 ± 1. 47,in routine therapeutic group were 1. 60 ± 1. 11,1. 65± 1. 19,1. 70 ± 1. 27 and 1. 70 ± 1. 38 and in TAPB group were 1. 70 ± 1. 27,1. 60 ± 1. 20,1. 55 ± 1. 20 and 1. 75 ± 1. 41 respectively. There was significantly statistical difference among control group,routine therapeutic group and TAPB group（ P〈0. 05）,but there was no significant difference between routine therapeutic group and TAPB group（ P〉0. 05）. The moving VAS scores at 4,8,12 and 24 hour after surgery in control group were 4. 65 ± 1. 53,4. 90 ± 1. 64,5. 30 ± 1. 62 and 5. 20 ± 1. 81,in routine therapeutic group were 3. 05 ± 1. 60,2. 95 ± 1. 63,3. 35 ±1. 59 and 3. 50 ± 1. 69,in TAPB group were 3. 00 ± 1. 64,3. 10 ± 1. 43,3. 30 ± 1. 62 and 3. 60 ± 1. 66 respectively. There was significantly statistical difference between control group and routine therapeutic group and between control group and TAPB group（ P〈0. 05）,but there was no difference between routine therapeutic group and TAPB group（ P〉0. 05）. The incidence rates of postoperative nausea and vomiting in control group,routine therapeutic group and TAPB group were 65. 0%,60. 0% and 55. 0% respectively. There was no statistical difference among these3 groups. The side effect of transversal abdominal plane block had not been found in patients of TAPB group. Conclusion Ultrasound-guided transversal abdominal plane block after gynecologic laparoscopic surgery is effective,and there is a trend of decreasing postoperative nausea and vomiting. It does not increase side effect,hence it is good for postoperative recovery. Ultrasound guided transversal abdominal plane block can provide satisfactory analgesia after gynecological laparoscopic surgery.