术前不同容量罗哌卡因腹横肌平面阻滞对腹腔镜卵巢癌根治术患者术后镇痛的改良作用

Efficacy of preoperative transversus abdominis plane block with different volumes of ropivacaine for improving postoperative analgesia in patients undergoing laparoscopic radical resection of ovarian cancer

目的评价术前不同容量罗哌卡因腹横肌平面（TAP）阻滞对腹腔镜卵巢癌根治术患者术后镇痛的改良作用。方法择期全麻下腹腔镜卵巢癌根治术患者60例，年龄30～60岁，BMI 18～24 kg/m^2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法将患者分为3组（n＝20）：0.375%罗哌卡因20 ml组（R1组）、0.375%罗哌卡因12 ml组（R2组）和对照组（C组）。R1组和R2组麻醉诱导前于超声引导下行双侧TAP阻滞术，分别注入0.375%罗哌卡因20 ml和12 ml。术后均采用1 μg/ml舒芬太尼行PCIA，负荷量2 ml，背景输注速率2 ml/h，PCA剂量0.5 ml，锁定时间15 min，维持VAS评分≤3分。当VAS评分〉3分时，静脉注射曲马多100 mg进行补救镇痛。记录术后24 h内PCIA舒芬太尼用量、有效按压次数、镇痛补救情况和不良反应的发生情况。分别于麻醉诱导前10 min、术后4、8、12和24 h时采集静脉血样，采用ELISA法测定血浆IL-6和IL-10的浓度。结果与C组比较，R1组和R2组舒芬太尼用量、有效按压次数、镇痛补救率、恶心呕吐和皮肤瘙痒的发生率降低，术后各时点血浆IL-6浓度降低，IL-10浓度升高（P〈0.05）；与R2组比较，R1组舒芬太尼用量、有效按压次数、镇痛补救率、恶心呕吐和皮肤瘙痒的发生率降低，术后各时点血浆IL-6浓度降低，IL-10浓度升高（P〈0.05）。R1组和R2组未见穿刺部位血肿和感染的发生。结论术前TAP阻滞可增强腹腔镜卵巢癌根治术患者术后镇痛效果，减少不良反应发生，其中0.375%罗哌卡因20 ml效果更佳。

Objective To evaluate the efficacy of preoperative transversus abdominis plane（TAP）block with different volumes of ropivacaine for improving postoperative analgesia in patients undergoing laparoscopic radical resection of ovarian cancer.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 30-60 yr, with body mass index of 18-24 kg/m2, scheduled for elective laparoscopic radical resection of ovarian cancer under general anesthesia, were divided into 3 groups（n=20 each）using a random number table： 0.375% ropivacaine 20 ml group（group R1）, 0.375% ropivacaine 12 ml group（group R2）and control group（group C）. In R1 and R2 groups, ultrasound-guided bilateral TAP block was performed before induction of anesthesia, and 0.375% ropivacaine 20 and 12 ml were injected, respectively.Both groups received patient-controlled intravenous analgesia（PCIA）with sufentanil after operation, and the PCIA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of 2 ml to maintain the visual analogue scale score ≤3.When the visual analogue scale score 〉3, tramadol 100 mg was intravenously injected as rescue analgesic.The consumption of sufentanil during PCIA, effective pressing times of PCIA, requirement for rescue analgesic and occurrence of adverse reactions were recorded within 24 h after operation.At 10 min before induction of anesthesia and 4, 8, 12 and 24 h after operation, venous blood samples were collected for measurement of the plasma concentrations of interleukin-6（IL-6）and IL-10 by enzyme-linked immunosorbent assay.Results Compared with group C, the consumption of sufentanil, effective pressing times of PCIA, requirement for rescue analgesic and incidence of nausea and vomiting and pruritus were significantly decreased, and the concentration of plasma IL-6 was decreased and the concentration of IL-10 in plasma was increased at each time point after operation in R1 and R2 groups（P〈0.05）. The consumption of sufentanil, effective pressing times of PCIA, requirement for rescue analgesic and incidence of nausea and vomiting and pruritus were significantly lower, and the concentration of plasma IL-6 was lower and the concentration of IL-10 in plasma was higher at each time point after operation in group R1 than in group R2（P〈0.05）. Hematoma and infection at the puncture site were not found in R1 and R2 groups.Conclusion Preoperative TAP block can enhance the postoperative analgesic efficacy, reduce the occurrence of adverse reactions, and 0.375% ropivacaine 20 ml provides better efficacy in patients undergoing laparoscopic radical resection of ovarian cancer.