TAPB联合氟比洛芬酯对腹腔镜结直肠癌根治术患者术后镇痛及快速康复的影响

Effect of transversus abdominis plane block combined with flurbiprofen axetil on postoperative analgesia and rapid recovery in patients undergoing laparoscopic radical resection of colorectal cancer

目的评价腹横肌平面阻滞(TAPB)联合氟比洛芬酯对腹腔镜结直肠癌根治术患者术后镇痛及快速康复的影响。方法择期行全身麻醉下腹腔镜结直肠癌根治术的患者75例,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,按随机数字表法分为3组(每组25例):对照组(C组)、TAPB组(T组)、TAPB联合氟比洛芬酯组(TF组)。C组仅接受全身麻醉;T组全身麻醉诱导后行超声引导下双侧TAPB,每侧各予0.375%罗哌卡因20 ml;TF组全身麻醉诱导后行超声引导下双侧TAPB并静脉注射氟比洛芬酯1 mg/kg。记录3组患者一般情况,术中丙泊酚及瑞芬太尼用量,术后2、6、12、24 h视觉模拟评分法(VAS)疼痛评分,术后24 h内舒芬太尼用量、镇痛泵首次按压时间、镇痛泵有效按压次数、补救镇痛率,术后首次下床时间、首次排气时间、住院时间。结果与C组比较:T组、TF组术中丙泊酚、瑞芬太尼用量较少,术后2、6、12、24 h VAS疼痛评分较低,镇痛泵首次按压时间较长,术后24 h内舒芬太尼用量、镇痛泵有效按压次数较少,术后首次下床时间、首次排气时间、住院时间较短(均P<0.05);TF组补救镇痛率较低(P<0.05)。与T组比较:TF组术中丙泊酚及瑞芬太尼用量较少,术后2、6、12 h VAS疼痛评分较低,镇痛泵首次按压时间较长,术后24 h内舒芬太尼用量、镇痛泵有效按压次数较少,术后首次下床时间、首次排气时间较短(均P<0.05)。结论TAPB联合氟比洛芬酯能够减少阿片类药物用量,显著改善术后疼痛,加速患者康复。

Objective To evaluate the effect of transversus abdominis plane block(TAPB)combined with flurbiprofen axetil on postoperative analgesia and rapid recovery in patients undergoing laparoscopic radical resection of colorectal cancer.Methods A total of 75 patients undergoing laparoscopic radical resection of colorectal cancer surgery under general anesthesia,American Society of Anesthesiologists(ASA)gradeⅠorⅡ,were selected.According to the random number table method,they were divided into three groups(n=25):a control group(group C),a TAPB group(group T),and a TAPB combined with flurbiprofen extranate group(group TF).Group C received general anesthesia alone.Meanwhile,ultrasound‑guided bilateral TAPB was performed in group T after anesthesia induction,where 0.375%ropivacaine was given at 20 ml on each side.After anesthesia induction,group TF was subject to ultrasound‑guided bilateral TAPB,while flurbiprofen axetil was intravenously given at 1 mg/kg.For patients in the three groups,their general information,and the intraoperative consumption of propofol and remifentanil were recorded.Their Visual Analogue Scale(VAS)scores on postoperative 2,6,12 h and 24 h were recorded.The consumption of sufentanil,the first time of pressing the analgesic pump,the total times of effective pressing the analgesic pump,and the rate of rescue analgesia,the time to first off-bed activity,the first exhaust time,and the length of hospitalization stay were recorded within 24 h after surgery.Results Compared with group C,group T and group TF showed decreases in the intraoperative consumption of propofol and remifentanil,lowered VAS scores on postoperative 2,6,12 h and 24 h,extended first time of pressing the analgesic pump,as well as the consumption of sufentanil,the times of effective pressing the analgesic pump,the time to first off‑bed activity,the first exhaust time,and the length of hospitalization stay within 24 h after surgery(all P<0.05),with a reduced rescue analgesic rate in group TF(P<0.05).Compared with group T,group TF presented decreases in the intraoperative consumption of propofol and remifentanil,lowered VAS scores on postoperative 2,6 h,and 12 h,extended first time of pressing the analgesic pump,the consumption of sufentanil within 24 h after surgery,the times of effective pressing the analgesic pump,the first off‑bed acitivity,and shortened first flatus time(all P<0.05).Conclusions TAPB combined with flurbiprofen axetil can reduce the consumption of opioids,significantly improve postoperative pain,and accelerate the rapid recovery of patients.