超声引导下连续腹横肌平面阻滞用于子宫全切术病人术后镇痛的效果

Efficacy of ultrasound-guided continuous transverses abdominis plane block when used for postoperative analgesia in patients undergoing total hysterectomy

目的评价超声引导下连续腹横肌平面阻滞用于子宫全切术病人术后镇痛的效果。方法择期全麻下行子宫全切术病人40例，年龄38～64岁，体重50～80 kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组：连续腹横肌平面阻滞组（CTAP组，n＝21）和病人控制静脉镇痛组（PCIA组，n＝19）。CTAP组术前超声引导下行双侧腹横肌平面阻滞，双侧分别注入0.2%罗哌卡因20 ml，拔除气管导管后双侧腹横肌平面分别输注0.2%罗哌卡因5 ml/h。PCIA组术毕拔除气管导管后采用舒芬太尼1 μg/ml行PCIA，背景输注速率2 ml/h，PCA剂量2 ml，锁定时间15 min。2组均持续镇痛至术后72 h。VAS评分〉4分时，肌肉注射吗啡5 mg补救镇痛。记录术后肠道功能恢复时间、住院时间、病人镇痛满意度、补救镇痛情况、腹横肌平面阻滞有关不良反应和术后恶心呕吐的发生情况。CTAP组分别于术毕即刻、术后2、6、12、24 、48和72 h时采集外周静脉血样，采用高效液相色谱法测定罗哌卡因血浆浓度和游离血浆浓度。结果与PCIA组比较，CTAP组镇痛补救率和恶心呕吐发生率降低，肠道功能恢复时间缩短，病人镇痛满意度评分升高（P〈0.05），住院时间差异无统计学意义（P〉0.05）。CTAP组未见腹横肌平面阻滞有关不良反应的发生。CTAP组罗哌卡因血浆浓度于术后2 h时开始升高，术后48 h时达峰值，游离血浆浓度于术后2 h时开始升高，术后24 h时达峰值（P〈0.05）。结论超声引导下连续腹横肌平面阻滞用于子宫全切术病人术后镇痛效果良好。

ObjectiveTo evaluate the efficacy of ultrasound-guided continuous transverses abdominis plane （TAP） block when used for postoperative analgesia in the patients undergoing total hysterectomy.MethodsForty American Society of Anesthesiologists physical status Ⅰ or Ⅱpatients, aged 38-64 yr, weighing 50-80 kg, undergoing elective total hysterectomy with general anesthesia, were divided into 2 groups using a random number table： continuous TAP block group （CTAP group, n=21） and patient-controlled intravenous analgesia （PCIA） group （n=19）. In group CTAP, bilateral TAP block was performed with 0.2% ropivacaine 20 ml under ultrasound guidance before operation, and 0.2% ropivacaine 5 ml/h was infused into bilateral TAPs after extubation.In group PCIA, the patients received PCIA with sufentanil 1 μg/ml after extubation, and the PCIA pump was set up to deliver a 2 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Analgesia lasted until 72 h after operation in both groups.When visual analog scale〉4, morphine 5 mg was intramuscularly injected as rescue analgesic.The recovery time of postoperative intestinal function, length of hospital stay, patient′s satisfaction with analgesia, requirement for rescue analgesia, TAP block-related adverse reactions and development of postoperative nausea and vomiting were recorded.In group CTAP, blood samples were collected from the peripheral vein immediately after the end of operation and at 2, 6, 12, 24, 48 and 72 h after operation for determination of concentrations of ropivacaine in plasma and free ropivacaine in plasma using high-performance liquid chromatography.ResultsCompared with group PCIA, the requirement for rescue analgesia and incidence of nausea and vomiting were significantly decreased, the recovery time of postoperative intestinal function was shortened, the score for patient′s satisfaction with analgesia was increased （P〈0.05）, and no significant change was found in the length of hospital stay in group CTAP （P〉0.05）. No TAP block-related adverse reactions were found in group CTAP.In group CTAP, the concentration of ropivacaine in plasma began to increase at 2 h after operation and peaked at 48 h after operation, the concentration of free ropivacaine in plasma began to increase at 2 h after operation and peaked at 24 h after operation （P〈0.05）.ConclusionUltrasound-guided continuous TAP block produces good analgesic efficacy when used for the patients undergoing total hysterectomy.