超声引导下多点肋缘下腹横肌平面阻滞在开腹胃癌根治术中的应用

Analgesic efficacy of ultrasound-guided subcostal multipoint transversus abdominis plane block in patients undergoing abdominal stomach cancer surgery

目的观察双侧多点肋缘下腹横肌平面阻滞(transversus abdominis plane block,TAP)对开腹胃癌根治术患者术后镇痛效果的影响。方法择期全麻下行开腹胃癌根治术患者60例,男35例,女25例,年龄50~70岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。全麻诱导成功后,超声引导下行双侧肋缘下多点腹横肌平面阻滞,两组患者分别注入0.5%罗派卡因40ml(研究组)或等量生理盐水(对照组)。手术结束患者清醒拔管后被推入PACU,患者离开PACU之前连接静脉自控镇痛泵。记录拔管后2、6、12、24和48h的疼痛VAS评分,记录术中舒芬太尼、瑞芬太尼及血管活性药物的总用量,术后镇痛泵按压次数及舒芬太尼的总用量。结果术后6、12、24h,研究组VAS评分明显低于对照组(P<0.05)。研究组术中舒芬太尼、瑞芬太尼和血管活性药物的总用量,术后镇痛泵按压次数,及术后舒芬太尼的总用量均明显少于对照组(P<0.05)。结论腹横肌平面阻滞通过阻滞前腹壁腹横肌平面的周围神经,为开腹胃癌根治术患者提供良好的术后镇痛。

Objective To observe the analgesic effect of abdominis plane block under bilateral costal margin in patients undergoing radical gastrectomy for gastric cancer.Methods Sixty patients with gastric cancer,35 males and 25 females,ASA physical statusⅠ orⅡ,were randomly divided into local anesthetic group（group R）and saline group（group C）.After induction of general anesthesia,ultrasound-guided flat knitting machine on bilateral rib flat knitting machine,the patients were injected 40 ml of 0.5% ropivacaine or saline.At the end of the operation,patients were pushed into the anesthesia recovery room after extubation,and patients were connected to the venous self-control analgesia pump before leaving the anesthesia room.The VAS pain scores 2,6,12,24,48 hafter extubation,the total dosage of sufentanil,remifentanil and vasoactive drugs were recorded.Results The VAS scores of group R 6,12 and 24 hafter operation were less than group C（P0.05）,but there was no statistical difference between the two groups at 2 hand 48 hafter operation.The total dosage of sufentanil,remifentanil and vasoactive drugs in group R were less than group C（P0.05）.The frequency of active pressure reduction in group R was significantly decreased after operation,and the consumption of sufentanil in group R was less than in group C（P〈0.05）.Conclusion Transversus abdominis plane block through the block anterior abdominal wall abdominis plane around the nerve provides open abdominal cancer surgery effective postoperative analgesia.