腹横肌平面阻滞联合无阿片药全麻对腹腔镜全子宫切除术围手术期镇痛效果的影响

Effect of transversus abdominis plane block combined with opioid-free anesthesia on perioperative analgesic effect in patients undergoing total laparoscopic hysterectomy

目的探讨超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞联合无阿片药麻醉(opioid-free anesthesia,OFA)对腹腔镜全子宫切除术围手术期镇痛效果的影响。方法选取择期行腹腔镜全子宫切除术的患者90例,按随机数字表法分为试验组(O组)和对照组(C组),每组45例。O组接受超声引导下TAP阻滞联合OFA,C组常规阿片药全麻。记录两组麻醉诱导前(T_(0))、麻醉诱导后(T_(1))、气管插管后(T_(2))、气腹后1 min(T_(3))、气腹后5 min(T_(4))、气腹后20 min(T_(5))和手术结束时(T_(6))的心率和MAP,记录术后睁眼时间、拔管时间、首次下床活动时间、首次肛门排气时间,记录术后2、6、12、24、48 h静息和活动数字分级评分法(Numerical Rating Scale,NRS)疼痛评分和Ramsay镇静评分,同时记录术后48 h内镇痛满意率和麻醉相关不良反应发生情况。结果与T_(0)时比较,T_(1)时C组心率、MAP和O组MAP明显降低(P<0.05),T_(2)时C组心率、MAP和O组心率明显增高(P<0.05);O组心率、MAP在T_(1)时明显高于C组(P<0.05);其余时点比较差异无统计学意义(P>0.05)。O组术后睁眼时间、拔管时间和首次肛门排气时间均明显短于C组(P<0.05),两组患者首次下床活动时间差异无统计学意义(P>0.05)。两组患者术后各时点NRS疼痛评分差异无统计学意义(P>0.05)。O组术后2 h Ramsay评分明显低于C组(P<0.05),其他时点差异无统计学意义(P>0.05)。两组患者术后48 h内镇痛满意率和麻醉相关不良反应发生情况差异均无统计学意义(P>0.05)。结论超声引导下TAP阻滞联合OFA用于腹腔镜全子宫切除术围手术期镇痛效果满意,术中血流动力学平稳,术后恢复质量高。

Objective To explore the effect of ultrasound-guided transversus abdominis plane(TAP)block combined with opioid-free anesthesia(OFA)on perioperative analgesic effect in patients undergoing total laparoscopic hysterectomy.Methods A total of 90 patients undergoing elective laparoscopic total hysterectomy were divided into two groups according to the random number table(n=45):an OFA group(group O)and a control group(group C).Patients in group T received ultrasound-guided TAP block combined with OFA,while group C received general anesthesia by conventional opioid drugs.The heart rate and the mean arterial pressure(MAP)were recorded before surgery(T_(0)),immediately after induction(T_(1)),immediately after intubation(T_(2)),1 min(T_(3)),5 min(T_(4))and 20 min after pneumoperitoneum(T_(5)),and at the end of surgery(T_(6)).The postoperative eye-opening time,time to extubation,the time of first off-bed activity,and the time of first anal exhaust were recorded.The Numerical Rating Scale(NRS)scores in resting and active state and Ramsay sedation scores at postoperative 2,6,12,24 h and 48 h were recorded.The rate of satisfaction with analgesia and adverse reactions within 48 h after surgery were also recorded.Results Compared with those at T_(0),the heart rate,MAP of group C and the MAP of group O significantly decreased at T_(1)(P<0.05),the heart rate,MAP of group C,the heart rate of group O significantly increased at T_(2)(P<0.05);the heart rate and MAP of group O at T_(1) were significantly higher than those of group C(P<0.05);there was no significant difference at other time points(P>0.05).Group O showed remarkable lower postoperative eye-opening time,time to extubation,and time of first anal exhaust than group C(P<0.05),and there was no significant difference in the time of first off-bed activity between the two groups(P>0.05).There was no significant difference in NRS score between the two groups at each time point(P>0.05).Group O presented significantly lower Ramsay's score than group C at postoperative 2 h(P<0.05),but there was no significant difference at other time points(P>0.05).There was also no significant difference in the rate of satisfaction with analgesia and adverse reactions within 48 h after surgery between the two groups(P>0.05).Conclusions Ultrasound-guided TAP combined with OFA can exert good analgesic effect on patients undergoing laparoscopic total hysterectomy,with stable intraoperative hemodynamics and good recovery quality.