Remazolam combined with transversus abdominis plane block in gastrointestinal tumor surgery:Have we achieved better anesthetic effects?

Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause strong stress reactions in patients.On the other hand,gastrointestinal surgery can cause stronger pain in patients,compared to other surgeries.Transversus abdominis plane block(TAPB)can effectively inhibit the transmission of nerve impulses caused by surgical stimulation,alleviate patient pain,and thus alleviate stress reactions.Remazolam is an acting,safe,and effective sedative,which has little effect on hemodynamics and is suitable for most patients.TAPB combined with remazolam can reduce the dosage of total anesthetic drugs,reduce adverse reactions,reduce stress reactions,and facilitate the rapid postoperative recovery of patients.

Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40(QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range(IQR)] of 175.5(170-189) com-pared to 170(160-175) in the control group(P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median(IQR) of 7.5(2.5-11.5) mg iv morphine equivalents compared to 13(7-21.5) in the control group(P = 0.07). Correlation analysis(Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores,-0.49(P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.

Effect of Subcostal Anterior Quadratus Lumborum Block vs.Oblique Subcostal Transversus Abdominis Plane Block after Laparoscopic Radical Gastrectomy

Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.

Application of remimazolam transversus abdominis plane block in gastrointestinal tumor surgery

BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect.However,the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023.The patients were categorized into a control group(n=51),receiving remimazolam for general anesthesia,and an observation group(n=51),receiving TAPB combined with remimazolam for general anesthesia.A comparison was made between both groups in terms of hemodynamic parameters,stress markers,pain levels,recovery quality,analgesic effects,and adverse reactions during the perioperative period.RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group(P<0.05).The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group(P<0.05).Five minutes after extubation,the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group(P<0.05).At 12 h,24 h,and 48 h following surgery,the visual analog scale scores of the observation group were considerably lower than those of the control group(P<0.05).The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group(P<0.05).The observation group exhibited considerably fewer effective pump presses,lower fentanyl dosages,and lower incidences of rescue analgesia within 24 h following surgery than the control group(P<0.05).CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good,which is helpful to promote faster recovery after operation.

Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Lornoxicam on Pain and Recovery Quality After Abdominal Surgery in Patients with Drug Addiction

Objective:This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in patients with a history of drug addiction.Methods:32 patients aged 18-60 who underwent lower abdominal surgery in the First People's Hospital of Liangshan Yi Autonomous Prefecture and Butuo County People's Hospital of Liangshan Yi Autonomous Prefecture from January 2022 to March 2023 were selected,the patients must have drug abuse history for more than 1 year,with a history of drug withdrawal and relapse.The patients were divided into observation group and control group by the envelope method,with 16 cases in the observation group and 16 cases in the control group.Two groups of patients underwent ultrasound-guided bilateral transversus abdominis plane block after the operation.The observation group was treated with dexmedetomidine hydrochloride 1μg/kg+0.25%ropivacaine hydrochloride 40ml,and the control group was treated with 40ml 0.9%sodium chloride injection,the two groups of patients returned to the ward after operation and given intravenous infusion of lornoxicam for relieving the pain.The visual analogue scale(VAS)score of postoperative pain,the times of rescue analgesia,the time of postoperative anal exhaust,the time of ambulation,nausea and vomiting,withdrawal symptoms,related adverse reactions,and hospitalization days were compared between the two groups.Results:The VAS score of postoperative pain in the observation group was significantly lower than that in the control group,P<0.05.Patients in the observation group used less postoperative rescue analgesics than those in the control group,P<0.05.For postoperative anal exhaust time,the difference between the two groups of patients was relatively small,and the time in the observation group was shorter,P>0.05.The time to get out of bed and the length of hospital stay were not significantly different between the control group and the observation group,P>0.05.The withdrawal symptoms of the patients in the observation group were better,P<0.05,nausea and vomiting,and other adverse reactions were lower in the control group,P<0.05.Conclusion:Ultrasound-guided transversus abdominis plane block combined with lornoxicam can be used to relieve pain in abdominal surgery for patients with drug addiction,which can effectively improve the therapeutic effect of patients and reduce the number of postoperative rescue analgesia.Thus,it has high clinical application value.

超声引导下TAPB联合罗哌卡因在腹腔镜胃癌根治术后镇痛中的应用研究进展

术后疼痛管理是围手术期麻醉管理的重要内容。腹横肌平面阻滞(TAPB)是一种新型麻醉阻滞方式,其能够有效阻断腹壁前侧感觉神经,具有较好的镇痛效果,已广泛应用于临床。目前,关于腹腔镜胃癌根治术后疼痛控制的研究仍不多,相关的总结和指导较少见,该文对超声引导下TAPB的现状、解剖学基础、入路方式、常用药物和阻滞方法等研究进行了综述,旨在为临床治疗提供循证依据。

剖宫产术I-TAP阻滞应用对术后的镇痛效果

目的:探讨髂腹股沟-腹横肌平面(I-TAP)阻滞与腹横肌平面(TAP)阻滞对剖宫产产妇术后镇痛效果的影响。方法:将2021年4月-2023年3月在本院产科计划剖宫产分娩的86例产妇随机分成TAP组与I-TAP组各43例,分别采用TAP阻滞麻醉或I-TAP阻滞麻醉。观察两组术后疼痛程度(VAS评分)、自控镇痛(PCA)按压次数、血清泌乳素(PRL)水平、不良反应。结果:I-TAP组VAS评分术后2h(1.29±0.32分)、4h(2.02±0.53分)、8h(2.84±0.82分)、16h(2.31±0.72分)、24h(2.33±0.52分)均低于TAP组(1.67±0.46分、2.55±0.70分、3.62±1.00分、2.97±0.81分、2.65±0.74分),PCA总按压次数(12.12±2.69次)、PCA有效按压次数(5.88±1.46次)均少于TAP组(14.46±4.57次、7.03±1.25次),两组术后1d血清PRL水平均升高,且I-TAP组(318.26±40.15μg/L)高于TAP组(251.65±32.67μg/L);不良反应发生率(9.3%)与TAP组(14.0%)无差异(P>0.05)。结论:I-TAP阻滞在剖宫产术麻醉中的应用效果优于TAP阻滞,可减轻产妇术后疼痛,减少PCA按压次数,提高术后PRL水平,且不良反应少,有效性与安全性均较好,值得应用。

艾司氯胺酮联合TAPB对妇科腹腔镜手术患者术后疼痛及康复的影响

目的:探讨艾司氯胺酮联合腹横筋膜阻滞(TAPB)在妇科腹腔镜手术中的应用,以及对患者术后疼痛与康复的影响。方法:将2021年1月-2023年12月本我院妇科行腹腔镜手术患者100例随机纳入T组、ET组各50例,T组予以TAPB麻醉,ET组予以艾司氯胺酮联合TAPB麻醉。观察两组术中麻醉药用量(丙泊酚、瑞芬太尼)、苏醒质量(拔管时间、恢复室停留时间)、术后疼痛(VAS评分)、康复指标(排气时间、下床活动时间、术后住院时间)、血清学指标白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)、不良反应。结果:ET组术中丙泊酚剂量(402.69±27.27 mg)、瑞芬太尼剂量(1.21±0.19 mg)、拔管时间(12.06±2.10 min)、恢复室停留时间(30.66±6.41 min)均少于T组(425.24±30.68 mg、1.60±0.25 mg、17.35±2.73 min、35.29±7.23 min),术后2h、6h、12h、24h、48hVAS评分均低于T组,排气(30.62±5.78h)、下床活动(35.50±6.21h)、术后住院时间(4.96±1.00d)均少于T组(36.41±6.15h、42.14±6.93h、5.61±1.14d),两组术后1d IL-6、TNF-α、NSE均高于术前但ET组均低于T组,不良反应发生率(6.0%)低于T组(20.0%)(均P<0.05)。结论:艾司氯胺酮联合TAPB用于妇科腹腔镜手术中的麻醉效果较好,可减少麻醉维持药量,提高苏醒质量,减轻术后疼痛,有助于术后康复,且能改善血清学指标,减少不良反应。

肋缘下TAPB联合单侧腹直肌鞘阻滞对腹腔镜胆囊切除术患者应激及苏醒质量的影响

目的探究肋缘下腹横肌平面阻滞(transversus abdominis plane block,TAPB)联合单侧腹直肌鞘阻滞在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用,观察对患者炎症应激及苏醒期质量、舒适度影响。方法选取在我院进行腹腔镜胆囊切除术患者85例,随机数字表法对患者进行分组,对照组(n=42)患者给予TAPB,观察组(n=43)患者行肋缘下TAPB联合单侧腹直肌鞘阻滞,2组均进行全身麻醉,对2组术后炎症应激水平进行观察,记录患者苏醒期质量,并对其术后舒适度进行评估。结果2组术前C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、血糖比较差异无统计学意义(P>0.05),与术前比较,术后患者的各指标值均上升,但观察组各炎症应激因子水平均低于对照组,差异有统计学意义(P<0.05)。比较2组术后24 h的视觉模拟评分(visual analog scale,VAS),可知术后各个时间段观察组的VAS评分均低于对照组,差异有统计学意义(P<0.05)。2组手术时间、术中出血量及住院时间比较,处于相同水平,差异无统计学意义(P>0.05),但观察组术后首次排气时间、苏醒时间及术后下床活动时间均短于对照组,差异有统计学意义(P<0.05)。术后2组BCS比较,观察组高于对照组,差异有统计学意义(P<0.05)。观察组患者出现各种不良反应症状的频率低于对照组,总不良反应发生率为18.60%,低于对照组(40.48%),差异有统计学意义(P<0.05)。结论LC术中应用肋缘下TAPB联合单侧腹直肌鞘阻滞可以提高患者术后舒适度及苏醒期质量,降低患者的炎症应激反应,具有临床应用价值。

地塞米松对罗哌卡因用于剖宫产术后TAP阻滞镇痛效果的影响

目的观察地塞米松对罗哌卡因用于剖宫产术后腹横肌平面(transversus abdominis plane,TAP)阻滞时间和效果的影响。方法将2013年7月至2014年5月间首都医科大学附属北京妇产医院收治的90例剖宫产产妇随机均分为三组,对照组(C组),罗哌卡因组(R组),地塞米松+罗哌卡因组(DR组)。术毕DR组和R组行TAP阻滞。记录所有产妇术后2小时、4小时、6小时、8小时、10小时、24小时、26小时、28小时静息和活动疼痛评分,镇痛泵药物用量,腹部温度觉平面恢复率,术后恶心呕吐评分,TAP并发症。结果 1三组术后2小时、4小时、6小时、8小时、10小时静息疼痛、活动疼痛评分差异具有显著性(P<0.05);24小时后差异无显著性(P>0.05)。2术后4小时、6小时、8小时、10小时、24小时DR组和R组镇痛泵药物用量低于C组(P<0.05);术后24小时DR组镇痛泵药物用量低于R组(P<0.05)。3术后2小时、4小时、6小时、8小时、10小时、24小时三组腹壁温度觉恢复率差异具有显著性(P<0.05),DR组低于R组,R组低于C组;术后26小时、28小时三组差异无显著性(P>0.05)。4C组术后排气时间较长(P<0.05)。5C组术后恶心呕吐发生率高于其他两组(P<0.05)。结论地塞米松可延长罗哌卡因用于剖宫产术后TAP阻滞镇痛的时间和增强镇痛效果。

TAP阻滞在妇科开腹手术中的镇痛效果观察

目的观察TAP阻滞在开腹子宫全切术及子宫肌瘤剔除术的镇痛效果。方法行开腹横切口子宫全切除术或子宫肌瘤剔除术的患者40例(ASAⅠ/Ⅱ),随机均分为对照组和TAP阻滞组,在全麻诱导后B超定位下行TAP阻滞,注射0.9%氯化钠注射液和罗哌卡因,记录和比较术中芬太尼用量、术后补救镇痛药需求量及术后疼痛评分。结果TAP组较对照组,术中芬太尼用量明显减少(p<0.05);术后补救镇痛药需求率更低(P<0.05)。术后4 h NRS疼痛评分更低(P<0.05)。结论TAP阻滞在妇科开腹术中、术后镇痛效果是安全确切的。

布托啡诺与罗哌卡因TAPB对妇科肿瘤腹腔镜手术患者的止痛效果及加速康复的影响

目的:探讨布托啡诺与罗哌卡因腹横肌平面阻滞(TAPB)对妇科肿瘤腹腔镜手术患者的止痛效果及加速康复的影响。方法:选取60例拟行腹腔镜手术妇科肿瘤患者为研究对象,按照TAPB注入的麻醉药物不同分为对照组和研究组,每组各30例。对照组每侧注入0.375%盐酸罗哌卡因注射液20 mL+0.9%氯化钠溶液1 mL;研究组每侧注入0.375%盐酸罗哌卡因注射液20 mL+0.1%酒石酸布托啡诺注射液1 mL。比较两组患者术中不同时刻心率(HR)和平均动脉压(MAP)水平,术中丙泊酚、瑞芬太尼用量,术后不同时刻视觉模拟评分(VAS),血清白细胞介素-6(IL-6)、IL-10含量,身体康复相关指标及药物不良反应发生率。结果:研究组切皮后5 min HR、MAP水平、术中瑞芬太尼用量及术后6、12、24 h VAS评分及术后24 h血清IL-6含量均低于对照组(P<0.05);排气时间、下床活动时间及住院时间均短于对照组(P<0.05);术后24 h IL-10含量、QoR-40评分均高于对照组(P<0.05)。结论:布托啡诺与罗哌卡因TAPB有利于维持妇科肿瘤腹腔镜手术患者术中血流动力学稳定,降低术中瑞芬太尼用量,提高止痛效果,加速术后康复进程,降低不良反应发生率,具有较高的安全性。

超声引导TAP阻滞、ESP阻滞对原位肝移植患者术后镇痛的效果观察

目的 比较术前超声引导下腹横肌平面阻滞(transversus abdominis plane block,TAPB)或竖脊肌平面阻滞(erector spinae plane block,ESPB)联合病人自控静脉镇痛(patient controlled intravenous analgesia,PCIA)对原位肝移植患者术后镇痛的应用效果。方法 选取45例行改良背驮式原位肝移植术患者,年龄为18~64岁,体重身高指数(body mass index,BMI)为18~24 kg/m^(2),ASA分级为Ⅲ~Ⅴ级,分为3组(n=15):术前TAPB组、术前ESPB组和常规PCIA镇痛组(C组)。TAPB组在全麻诱导后经B超引导下行双侧肋缘下入路两点腹横肌平面阻滞,每点注入混合药液(0.33%罗哌卡因30 ml+地塞米松5 mg)15 ml。ESPB组在全麻诱导后经B超引导下行双侧T7水平竖脊肌平面阻滞,每侧注入混合药液(0.33%罗哌卡因30 ml+地塞米松5 mg)30 ml。C组为常规PCIA镇痛组,术前不行神经阻滞。三组术后均使用舒芬太尼2μg/kg PCIA镇痛泵,若术后48 h内疼痛评分VAS≤3分,予静脉单次追加舒芬太尼5μg行补救镇痛。记录术中瑞芬太尼用量和拔除气管导管时间。观察术后48 h内舒芬太尼补救镇痛用量、恶心呕吐、皮肤瘙痒和呼吸抑制的发生情况。结果 与C组比较,TAPB组和ESPB组术中瑞芬太尼及术后补救镇痛舒芬太尼用量均减少,拔除气管导管时间缩短,术后不良反应发生率降低(P <0.05)。ESPB组和TAPB组比较,术中瑞芬太尼用量、术后48 h内舒芬太尼补救镇痛用量减少(P <0.05),拔除气管导管时间、术后不良反应发生率均无统计学差异(P> 0.05)。结论 术前超声引导TAPB或ESPB联合PCIA静脉镇痛对原位肝移植手术患者均能提供良好的镇痛效果,不良反应少,与TAPB相比,ESPB静脉镇痛药物的用量少。

超声引导下TAP阻滞对宫颈癌根治术患者术后镇痛效果的影响

目的观察超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于宫颈癌根治手术后的镇痛效果。方法 50例全麻下行宫颈癌根治术患者,随机分为术后腹横肌平面阻滞(TABP)+患者自控静脉镇痛(PCIA)(研究组)及单纯PCIA组(对照组),每组各25例,术后均使用静脉自控镇痛泵。分别记录两组患者术后清醒拔管即刻、2、6、12和24小时的VAS及Ramsay评分;第1次需求PCA距离清醒拔管的时间、术后24小时镇痛泵药物使用量及术后24小时镇痛泵按压次数;术后不良反应发生情况。结果研究组患者术后各时间点VAS评分均低于对照组(P<0.01),Ramsay镇静评分在T0和T1时点均高于对照组(P<0.05)。研究组患者第1次需求PCA距离清醒拔管的时间明显长于对照组(P<0.01);术后24小时镇痛泵药物使用量及按压次数明显少于对照组(P<0.01);术后镇痛的恶心呕吐发生率明显低于对照组(P<0.05)。结论超声引导下TAP阻滞用于经腹宫颈癌根治术能明显减少术后镇痛药的需要量及副反应,增加镇痛效果。

TAP对腹腔镜子宫切除患者血浆皮质醇的影响

目的探讨超声引导腹横肌平面阻滞(TAP)对腹腔镜子宫切除患者血浆皮质醇和血流动力学影响。方法将80例择期手术的子宫肌瘤患者随机分为对照组(B组)及观察组(A组)各40例,两组患者均采用丙泊酚、芬太尼、维库溴铵施行麻醉诱导,丙泊酚、瑞芬太尼、维库溴铵维持麻醉。A组全麻插管后,再经超声引导腹横肌平面阻滞后接受腹腔镜手术,观察两组患者麻醉前(T0)、麻醉后60 min(T1)、拔管后5 min(T2)、术后2h(T3)、以及术后24 h(T4)的MAP、HR、血浆皮质醇(Cor)和VAS评分变化。结果与T0比较,两组患者T1时HR显著降低,T2时MAP、HR、Cor明显增高(P<0.05)。与A组比较,B组患者T3、T4时Cor明显增高(P<0.05),T3时MAP、VAS评分明显增高,镇痛泵按压次数和芬太尼用量组明显增多(P<0.05),差异有统计学意义。结论与单独使用全身麻醉相比,超声引导TAP可以为腹腔镜子宫切除患者提供更好的术中血浆皮质醇浓度和血流动力学控制,降低阿片类药物的需求和术后视觉模拟痛觉评分(VAS)。

不同剂量氢吗啡酮复合罗哌卡因超声引导TAPB用于妇科腹腔镜手术术后镇痛的效果

目的探究不同剂量氢吗啡酮复合罗哌卡因超声引导下腹横肌平面阻滞(TAPB)用于对妇科腹腔镜手术术后镇痛的效果。方法选取2020年6月至2022年9月福鼎市医院收治的108例行妇科腹腔镜手术的患者作为研究对象,采用随机数表法分为对照组(n=54)和观察组(n=54)。两组均在全身麻醉后接受超声引导下TAPB。对照组给予低剂量氢吗啡酮联合罗哌卡因,观察组给予高剂量氢吗啡酮联合罗哌卡因。比较两组术中镇静、镇痛药的用量及苏醒、拔管时间,术前、术后10 min及术后2 d时疼痛相关介质水平,术后0.5、1、2 d休息和活动疼痛情况及术后不良反应情况。结果观察组术中镇静、镇痛药的用量明显低于对照组(P<0.05);两组患者苏醒与拔管时间比较,差异无统计学意义(P>0.05)。术前及术后10 min,两组疼痛相关介质5-羟色胺(5-HT)、P物质(SP)、前列腺素E2(PGE2)及β内啡肽(β-EP)水平比较,差异无统计学意义(P>0.05);术后2 d,两组5-HT、SP、PGE2及β-EP水平均低于术后10 min,且观察组上述水平显著低于对照组,差异有统计学意义(P<0.05)。观察组术后0.5、1、2 d休息和活动时视觉模拟量表(VAS)评分低于对照组,差异有统计学意义(P<0.05)。两组术后不良反应总发生率比较,差异无统计学意义(P>0.05)。结论大剂量氢吗啡酮复合罗哌卡因超声引导下TAPB用于妇科腹腔镜手术,有助于减少术中镇静、镇痛药的用量,降低疼痛相关介质水平,缓解患者休息和活动时的疼痛感受。

罗哌卡因复合右美托咪定TAPB用于妇科腔镜术后镇痛的临床观察

目的分析探讨罗哌卡因复合右美托咪定双侧腹横肌平面阻滞(TAPB)用于妇科腔镜术后镇痛的临床观察。方法选取104例需要在全麻腹腔镜下实施子宫肌瘤剔除手术治疗的患者,随机分为甲、乙、丙、丁四组,其中甲组患者给予罗哌卡因局部麻醉,乙组患者给予罗哌卡因双侧TAPB,丙组患者给予右美托咪定复合罗哌卡因双侧TAPB,丁组患者不给予任何药物。术后四组患者均采用自控静脉镇痛(PCIA)。记录四组患者镇痛后即时(T0)、4 h(T1)、8 h(T2)、18 h(T3)、36 h(T4)、48 h(T5)的平均动脉压以及PCIA按泵次数、恶心呕吐次数、疼痛视觉模拟评分(VAS)、止痛药用量等。结果甲组患者在T1、T2时间点的平均动脉压明显低于丁组患者(t分别=3.74、4.13,P均<0.05);乙组和丙组患者的T1、T2、T3时间点的平均动脉压均明显低于丁组患者(t分别=4.66、3.74、4.55;4.36、3.33、3.48,P均<0.05)。乙组患者在T1、T2时间点的VAS评分明显低于丁组患者(t分别=3.29、4.10,P均<0.05);丙组患者在T1、T2、T3、T4、T5时间点的VAS评分均明显低于丁组患者(t分别=3.23、4.21、3.21、4.32、3.75,P均<0.05)。甲组患者在T3和T4时间点的按压镇痛泵次数少于丁组患者(t分别=4.63、3.56,P均<0.05);乙组患者在T1、T3、T4时间点的按压镇痛泵次数少于丁组患者(t分别=3.45、4.34、3.55,P均<0.05);丙组患者在T1、T2、T3、T4时间点的按压镇痛泵次数少于丁组患者(t分别=4.43、3.55、4.59、3.82,P均<0.05)。甲组患者在T2时间点的镇痛药物使用量低于丁组患者(t=4.28,P<0.05);乙组患者在T1和T2时间点的镇痛药物使用量低于丁组患者(t分别=4.44、4.38,P均<0.05);丙组患者在T1、T2、T3以及T4时间点的镇痛药物使用量均低于丁组患者(t分别=4.72、4.88、4.22、4.38,P均<0.05)。结论在妇科腹腔镜手术中应用罗哌卡因-右美托咪定混合液行TAPB联合术后自控静脉镇痛多模式镇痛能够有效缓解患者的术后疼痛,并且能够提供较为稳定的术后血压。

超声引导下I-TAP+LA在老年患者腹股沟疝手术中的应用

目的探讨超声引导下腹横肌平面阻滞联合髂腹下髂腹股沟神经阻滞加切口局部浸润(I-TAP+LA)在老年患者腹股沟疝修补术中的麻醉效果。方法选取60例择期行开放性腹股沟疝修补术的老年患者,应用随机数字表法将患者分为I-TAP+LA组(T组)和硬膜外组(C组),每组30例。记录两组患者的麻醉效果、麻醉操作用时、术后疼痛情况、麻醉并发症发生情况、血流动力学变化、麻醉费用。结果两组麻醉效果差异无统计学意义(P>0.05);T组的麻醉操作用时短于C组(P<0.05),T组麻醉并发症发生情况、麻醉费用、对患者血流动力学的影响优于C组(P<0.05);T组术后镇痛时间较C组延长(P<0.05)。结论超声引导下I-TAP+LA在老年患者腹股沟疝手术中麻醉效果确切、血流动力学稳定,降低了术后24h内的疼痛情况。

TAPB联合剖宫产术后应用舒芬太尼静脉自控镇痛对产妇应激反应和舒适度的影响

目的超声引导下腹横肌平面阻滞(TAPB)联合剖宫产术后应用舒芬太尼静脉自控镇痛(PCIA)对产妇镇痛镇静以及舒适度的影响。方法选取2019年1月至6月唐山市妇幼保健院拟行择期剖宫产手术的78例足月初产妇作为研究对象。依据双盲随机原则分成观察组(n=39)和对照组两组(n=39)。观察组产妇术后使用TAPB(0.375%罗哌卡因20mL)联合PCIA[舒芬太尼0.05μg/(kg·h)]镇痛,对照组产妇术后只采用PCIA。分别使用舒适度评分量表(BCS)、视觉模拟评分(VAS)以及Ramsay镇静量表评估两组产妇术后4h、12h、24h和48h的舒适度、镇静镇痛效果;比较两组产妇舒芬太尼用量和不良反应情况。结果观察组产妇术后各时间点VAS评分、Ramsay评分均显著低于对照组产妇,BCS评分高于对照组产妇,组间差异具有统计学意义(P<0.05);观察组产妇舒芬太尼用量少于对照组产妇,差异具有统计学意义(P<0.05);两组产妇不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下腹横肌平面阻滞联合剖宫产术后静脉自控镇痛能够减少阿片类药物使用剂量,缓解手术创伤造成的生理应激反应,提升产妇舒适度。

肺保护性通气策略联合超声引导下TAP阻滞在小儿日间腹腔镜疝气修补术中的临床观察

目的:探讨肺保护性通气策略联合超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞在小儿日间腹腔镜疝气修补术中的临床效果。方法:选取2019年9月-2020年10月在本院行小儿日间腹腔镜疝气手术的患儿80例,按随机数字表法分为肺保护性通气策略联合超声引导下TAP阻滞组(观察组,40例)和肺保护性通气策略组(对照组,40例)。比较两组患儿入室(T0)、麻醉诱导后(T1)、插管后1 min(T2)、气腹时(T3)及气腹10 min(T4)的血流动力学指标[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、脉搏血氧饱和度(pulse oxygen saturation,SpO_(2))];记录两组患儿手术时间、拔管时间、苏醒时间及住院时间;采用患儿麻醉苏醒期躁动量化评分表(PAED)评估术后躁动程度;采用FIACC疼痛评分表评估患儿术后1 h(T5)、2 h(T6)、4 h(T7)的疼痛程度。结果:两组HR,MAP均呈先降低,逐渐趋向平稳,但两组间的HR,MAP,SpO_(2)相比差异均无统计学意义(P>0.05)。两组的手术时间、拔管时间、苏醒时间比较差异均无统计学意义(P>0.05)。与对照组相比,观察组的住院时间短,差异有统计学意义(P<0.05)。观察组术后PAED评分和术后T5、T6、T7的FLACC评分比对照组低,差异均有统计学意义(P<0.05)。结论:小儿日间腹腔镜疝气修补术患儿术中采用肺保护性通气策略联合超声引导下TAP阻滞,可以维持术中血流动力学稳定,降低术后躁动和疼痛的发生,缩短住院时间,加快术后康复。