超声引导下腹横肌平面阻滞对于妇科腹腔镜手术患者预防性镇痛的效果

Efficacy of ultrasound-guided transversus abdominis plane(TAP) block for preventive analgesia in patients underwent gynecological laparoscopy

目的评价超声引导下腹横肌平面阻滞(TAPB)对于妇科腹腔镜手术患者预防性镇痛的效果。方法选取拟在全麻下行妇科腹腔镜手术患者60例,既往无其他特殊病史,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄30~50岁,体重50~65 kg。采用随机数字表法,将其分为3组(n=20):对照组(Ⅰ组)、术前TAPB组(Ⅱ组)和术后TAPB组(Ⅲ组)。Ⅰ组不实施神经阻滞,Ⅱ组和Ⅲ组分别于麻醉诱导前或手术结束后行超声引导下双侧TAPB术。术后3组患者均采用1μg/ml舒芬太尼静脉自控镇痛(PCIA),背景输注速率2 ml/h,患者自控镇痛(PCA)剂量2 ml,锁定时间15 min,持续至术后第2天,维持疼痛视觉模拟(VAS)评分≤3分,若VAS评分>3分时,静脉注射氟比洛芬酯50 mg行镇痛补救。记录术后24 h内舒芬太尼单位时间内用量、镇痛补救情况和不良反应的发生情况,计算舒芬太尼节俭程度。结果与Ⅰ组比较,Ⅱ组和Ⅲ组术后24 h内舒芬太尼单位时间内用量、镇痛补救率和恶心呕吐的发生率降低(P<0.05);与Ⅲ组比较,Ⅱ组术后24 h内舒芬太尼单位时间内用量、镇痛补救率及恶心呕吐的发生率降低(P<0.05)。Ⅱ组较Ⅰ组舒芬太尼用量节俭35.0%,较Ⅲ组舒芬太尼用量节俭16.0%。结论超声引导下TAPB能为妇科腹腔镜手术患者提供良好的术后镇痛,术前行神经阻滞效果优于术后。

Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane(TAP)block for preventive analgesia in patients undergoing gynecological laparoscopy.Methods60ASA physical status I^II,aged30~50yr,weighting50~65kg patients scheduled for elective gynecological laparoscopy were randomly divided into3groups using a random number table(n=20each):control group(group I),preoperative TAP block group(group II)and postoperative TAP block group(group III).Ultrasound-guided bilateral TAP block was performed before induction of anesthesia or at the end of surgery in II and III groups,respectively.Patient-controlled intravenous analgesia(PCIA)with1μg/ml sufentanil(background infusion2ml/h,bolus dose2ml,lockout interval15min)was used until2days after surgery and VAS score was maintained≤3.When VAS score>3,flurbiprofen axetil50mg was injected intravenously as rescue medication.The consumption of sufentanil per hour,requirement for rescue medication,and development of adverse reactions were recorded within24h after surgery.Sufentanilsparing degree was calculated.Results Compared with group I,the consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within24h after surgery in II and III groups(P<0.05).The consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly lower in group II than in group III(P<0.05).The consumption of sufentanil was decreased by35.0%in group II as compared with group I,and decreased by16.0%in group II as compared with group III.Conclusion Ultrasound-guided TAP block can provide good postoperative analgesia in patients undergoing gynecological laparoscopy,and effect of preoperative nerve block is better than that of postoperative nerve block.