腹横肌平面阻滞和局麻药切口浸润的多模式镇痛在腹腔镜结直肠癌手术中的比较研究

Comparison of transversus abdominis plane block with wound infiltration for multimodal analgesia after laparoscopic colorectal resection

目的比较腹腔镜结直肠癌手术中腹横肌平面阻滞和局麻药切口浸润的术后镇痛效果。方法选取80例择期腹腔镜结直肠癌手术患者,查随机数字表,将患者随机分为腹横肌平面阻滞组(TAP组)和局麻药伤口浸润组(WA组)各40例。两组患者均采用多模式镇痛方式,手术结束前30 min,安置静脉PCA镇痛泵。比较两组术后24 h补救性镇痛药给予次数和舒芬太尼用量。结果 TAP组2例和WA组3例患者中转开腹,共75例患者(TAP 37例,WA 38例)数据纳入统计分析。术后8 h咳嗽时,WA组VAS评分大于TAP组,差异有统计学意义(P<0.05);其它时间点两组VAS评分比较,差异无统计学意义(P>0.05)。两组术后24 h给予补救性镇痛药次数、24 h舒芬太尼用量及术后恶心、呕吐和肛门排气时间比较,差异均无统计学意义(均P>0.05)。结论腹腔镜结直肠癌手术中,腹横肌平面阻滞和局麻药切口浸润的术后多模式镇痛效果相当。

Objective To compare the analgesia effect of transversus abdominis plane block with wound infiltration after laparoscopic colorectal resection.Methods Eighty patients were randomly divided into transversus abdominis plane block （ TAP） group and wound infiltration （ WA） group, 40 in each group.Multimodal analgesia was used in all patients and PC A via vein was performed at 30 min before surgery finished.The rescue analgesics usage and sufentanil consumption during 24 h were compared between the two groups.Results Because 2 cases in the TAP group and 3 cases in the WA group were changed to open operation,a total patients of 75 patients （TAP= 37 and WA= 38） were involved for analysis.The VAS scores in the WA group was significantly higher than those in the TAP group when patients coughed after 8 h of operation （ P 〉0.05）.However, there was no significant difference in other time points between the two groups （P 〉 0.05 ）.No significant difference was found in rescue analgesics usage, sufentanil consumption during 24 h, postoperative nausea and vomiting, and passage of gas between the two groups （ P〉0.05 ） .Conclusion The multimodal an-algesia effect of transversus abdominis plane block and wound infiltration is equal after laparoscopic colorectal resection.