超声引导下后路和肋缘下入路TAP对腹腔镜胆囊切除术后镇痛效果的比较

Comparison of ultrasound-guided posterior and subcostal approaches transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy

目的比较超声引导下的肋缘下入路腹横肌平面阻滞(TAP)阻滞与后路TAP阻滞对于腹腔镜胆囊切除术患者的术后镇痛效果。方法选择本院2018年6月至2019年6月行腹腔镜胆囊切除术的60名患者为研究对象,设计前瞻性、随机对照、双盲临床试验,将所有患者随机分为三组,分别为全身麻醉组、后路TAP阻滞组及肋缘下入路TAP阻滞组。I组患者接受标准的全身麻醉(对照组);II组患者接受超声引导下后路TAP阻滞,每侧使用15 ml 0.375%罗哌卡因;III组患者接受超声引导下肋缘下入路的TAP阻滞,两侧各15 ml 0.375%罗哌卡因。观察指标:评估患者术后0、2、4、6、8、12和24 h静息和运动状态下的疼痛VAS评分,记录首次按压镇痛泵的时间、术后镇痛药物的用量以及恶心、呕吐和过度镇静等并发症的发生。结果术后随访结果证实,术后4 h以内II组及III组患者在静息和运动时的疼痛评分相当(P>0.05),并且显著低于I组患者(P<0.05);但术后4 h以后,III组患者的术后镇痛效果明显优于II组患者(P<0.05)。结论对于脐平面以上区域切口的腹部手术,肋缘下入路的TAP阻滞能够比后路TAP阻滞提供更好的术后镇痛效果。

Objective To compare ultrasound-guided posterior and subcostal approaches transverse abdominis plane(TAP)block for postoperative analgesia in laparoscopic cholecystectomy.Methods This was a prospective,randomized,double-blind clinical study.60 adult patients scheduled for elective laparoscopic cholecystectomy in our hospital from June 2018 to June 2019 were randomly divided into three groups.Group 1 received standard general anesthesia(control group);group 2 received ultrasound-guided posterior approach TAP block with 15 ml of 0.375%ropivacaine on each side;group 3 received ultrasound-guided subcostal approach TAP block with 15 ml of 0.375%ropivacaine on each side.The presence and severity of pain during rest and movement were assessed in all patients postoperatively at 0,2,4,6,8,12,and 24-hour intervals.Besides,the time to first press the analgesic pump,the amount of postoperative analgesic drug,nausea or vomiting and excessive sedation after surgery were recorded.Results The severity of pain during rest and movement of group 2 and 3 were similar within postoperative 4 h(P>0.05),which were significantly lower than those of group 1(P<0.05).After postoperative 4 hours,postoperative analgesic effect of group 3 was significantly better than that of group 2(P<0.05).Conclusion For incisions mainly involving the supra-umbilical region,subcostal TAP block may be a better alternative than posterior approach for providing postoperative analgesia.