腹外斜肌肋间平面阻滞与腹横肌平面阻滞在胆囊切除术术后镇痛效果的比较

Comparison of analgesic effect ofintercostal planeblock of external oblique muscleand transversus muscle plane block ofabdomenafter cholecystectomy

目的比较腹外斜肌肋间平面阻滞(External oblique intercostal block,EOIB)与腹横肌平面阻滞(Transverse abdominis plane block,TAPB)在腹腔镜下胆囊切除术(Laparoscopic cholecystectomy,LC)术后的镇痛效果。方法选取2023年2月-6月在山东第一医科大学第一附属医院(山东省千佛山医院)麻醉与围术期医学科行LC手术的74例患者为研究对象,采用随机数字表法分为E组和T组,每组37例。E组接受EOIB,T组接受TAPB,均行全程静脉麻醉,两组术后2、6、12、24 h均采用视觉模拟量表(Visual analogue Scale,VAS)评估患者静息及运动时疼痛程度。比较两组术中舒芬太尼和瑞芬太尼用量、术后首次排气时间、首次下床时间、住院时间、术后不良反应发生率、术后6 h Ramsay镇静评分、术后额外使用镇痛药的例数及术后满意度。结果与T组术后6 h静息时比较,E组VAS评分低(P<0.05);与T组术后2、6、12、24 h运动时比较,E组VAS评分低(P<0.05);与T组比较,E组术后首次排气时间、首次下床时间、住院时间短,恶心发生率低(P<0.05)。两组术中舒芬太尼和瑞芬太尼用量,术后Ramsay镇静评分及术后额外使用镇痛药的例数比较,差异无统计学意义(P>0.05)。结论EOIB应用于LC患者在改善术后镇痛效果、促进术后恢复、降低恶心发生率、提高术后满意度方面具有一定优势。

Objective To compare the effects of external oblique intercostal block(EOIB)and transversus abdominis planeblock(TAPB)in postoperativeanalgesia after laparoscopiccholecystectomy.Methods A total of 74 patients scheduled to undergo laparoscopic cholecystectomy(LC)in the hospitalin February and June 2023 were selected as study subjects.Thepatients were randomly divided into Group E and Group T using a random number table method,with 37 patients in each group.Group E received EOIB,Group T received TAPB,and both groups received total intravenous anesthesia.At 2,6,12,and 24 hours after surgery,both groups were evaluated for pain levels during rest and exercise using Visual Analog Scale(VAS).Compare the intraoperative dosages of sufentanil and remifentanil between two groups,the time of first postoperative ventilation,time of first ambulation,length of hospital stay,incidence of postoperative adverse reactions,Ramsay sedation score at 6 hours post surgery,number of additional postoperative analgesics used,and postoperative satisfaction.Results Compared with group T at rest 6 hours after surgery,group E had a lower VAS score(P<0.05).Compared with group T at 2,6,12 and 24 hours of postoperative exercise,group E had a lower VAS score(P<0.05).Compared with group T,group E had a shorter time for first postoperative exhaust,first time out of bed,hospital stayand a lower incidence of nausea(P<0.05).There was no statistically significant difference(P>0.05)in the amount of sufentanil and remifentanil used during surgery,postoperative Ramsay sedation score,and the number of additional postoperative analgesics between the two groups.Conclusion Compared with TAPB,EOIB applied to LC patients shows certain advantages in improving the postoperative analgesia effect,promoting postoperative recovery,reducing the incidence of nausea and improving postoperative satisfaction.