国际麻醉学与复苏杂志   2017, Issue (6): 11-11
    
不同时点的腹横肌平面阻滞对腹部腔镜术中及术后镇痛效果的影响
孙怡1()
1.广东省人民医院麻醉科,广东省医学研究院
The influence of transversus abdominis plane on intraoperative and postoperative analgesia at different time points in the abdomen laparoscopy operations
 全文:
摘要:

摘要:目的 比较术前和术后腹横肌平面阻滞(transversus abdominis plane, TAP)对腹部腔镜手术患者术中和术后镇痛效应的影响。方法 120例全麻下行腹腔镜肠道手术患者随机分为A、F和C组,A和F组患者分别在切皮前和手术后进行B超引导下双侧TAP, 0.4%罗哌卡因共注射40ml。C组患者则给予同量0.9%生理盐水。所有患者术后均使用Fentanyl静脉输注自控镇痛泵。比较三组术中切皮前后血流动力学改变、术中麻醉药物用量、术后3,6,12,24,30和48小时Fentanyl用量、视觉模拟(VAS)评分和副反应等。结果 三组患者切皮前后血流动力学指标差异无统计学意义(P>0.05)。A组的镇痛药用量小于F和C组(P<0.05)。术后3、6、12和24h时,A和F组患者在安静与咳嗽时的VAS评分和fentanyl用量均低于C组(P<0.05);30h时,F组患者VAS评分和Fentanyl用量分别低于A组和C组(P<0.05);3h时,F组的Fentanyl用量高于A组(P<0.05)。三组术后恶心、呕吐等副作用比较无统计学差异。结论 TAP的镇痛作用与局麻药阻滞作用时间相关联。术前或术后TAP在镇痛作用上没有显著差异。

关键词: 腹横肌平面阻滞;快速康复;术后镇痛;腹腔镜
Abstract:

Abstract: Objectives To compare the influence of transversus abdominis plane (TAP) on intraoperative and postoperative analgesia at different time points in the abdomen laparoscopy operations. Methods 120 patients undergoing abdomen laparoscopy under general anesthesia were allocated randomly to receive TAP block with 0.4% ropivacaine 40ml, either pre-incisional (group A), or at the end of surgery (group F) or sham block (saline, group C). Hemodynamic parameters during skin incision,peri-operative analgesic requirements, the amount of postoperative fentanyl and the side effects were recorded. Pain was evaluated postoperatively while coughing and at rest by visual analogue scale at 3,6,12,24,30,48h after operation. Results Hemodynamic parameters among three groups were comparable. The usage of Remifentanyl in group A was lower than that in group F and C (P<0.05). Fentanyl requirement and pain scores were lower in group A and F than in group C at 3,6,12,24h after operation (P<0.05), while those were lower in group F than in group A and C at 30h postoperatively (P<0.05). Compared with group A, Fentanyl requirement in group F was higher at 3h postoperatively(P<0.05). Incidence of postoperative nausea and vomiting were no significant different. Conclusion Our results suggest that TAP block seems to be related with the acting time of local analgesic and no significant difference on analgesic effects of TAP either pre-incisional TAP or at the end of operation.

Key words: TAP; ERAS; postoperative analgesia; laparoscopy