背景:腹直肌鞘阻滞(RSB)和腹横肌平面阻滞(TAPB)已被证明可以减少阿片类药物的消耗并降低腹部手术的术后疼痛评分。然而,目前尚无关于RSB联合TAPB一穿刺技术在腹腔镜上腹部手术围手术期疼痛管理的报道。
方法:将58例患者随机分为对照组(C),TAP组(T),RSB联合TAPB组(RT)的一次穿刺技术。C组患者未接受任何区域阻滞。T组患者接受超声引导下肋下TAPB,每侧30mL罗哌卡因0.33%。RT组的患者通过一次穿刺技术在每个平面中接受RSB和TAPB的组合以及15mL的0.33%罗哌卡因。所有患者术后均接受患者自控静脉镇痛(PCIA)。在区域块完成后20分钟记录块的范围。术后阿片类药物的消耗,疼痛评分,并记录恢复数据,包括出现躁动(EA)的发生率,第一次排气和离床活动的时间,术后恶心呕吐的发生率,头晕。
结果:RT组的一次穿刺技术范围涵盖了手术切口的所有区域。在术后4、8、12和24h,RT组的视觉模拟评分(VAS)评分在休息和咳嗽期间明显低于T和C组,分别为(P<0.05)。RT组术后24、48h舒芬太尼用量和镇痛泵按压次数均显著低于T、C组(P<0.05)。RT组EA发生率明显低于T组和C组(P<0.05)。
结论:RSB联合TAPB的一次穿刺技术为腹腔镜上腹部手术提供了有效的术后镇痛,降低PACU期间EA的发生率,促进早日康复。
背景:ChiCTR,ChiCTR2300067271。注册时间为2023年1月3日,http://www。chictr.org.cn.
BACKGROUND: Rectus sheath block (RSB) and transversus abdominis plane block (TAPB) have been shown to reduce opioid consumption and decrease postoperative pain scores in abdominal surgeries. However, there are no reports about the one-puncture technique of RSB combined with TAPB for perioperative pain management during laparoscopic upper abdominal surgery.
METHODS: A total of 58 patients were randomly assigned to the control group (C), the TAP group (T), and the one-puncture technique of RSB combined with TAPB group (RT). The patients in group C did not receive any regional block. The patients in group T received ultrasound-guided subcostal TAPB with 30 mL of 0.33% ropivacaine on each side. The patients in the RT group received a combination of RSB and TAPB with 15 mL of 0.33% ropivacaine in each plane by one puncture technique. All patients received postoperative patient-controlled intravenous analgesia (PCIA) after surgeries. The range of blocks was recorded 20 min after the completion of the regional block. The postoperative opioid consumption, pain scores, and recovery data were recorded, including the incidence of emergence agitation (EA), the times of first exhaust and off-bed activity, the incidence of postoperative nausea and vomiting, dizziness.
RESULTS: The range of the one-puncture technique in group RT covered all areas of surgical incisions. The visual analogue scale (VAS) score of the RT group is significantly lower at rest and during coughing compared to groups T and C at 4, 8, 12, and 24 h after surgery, respectively (P < 0.05). The consumption of sufentanil and the number of postoperative compressions of the analgesic pumps at 24 and 48 h in the RT group are significantly lower than those in groups T and C (P < 0.05). The incidence of EA in the RT group is significantly lower than that in groups T and C (P < 0.05).
CONCLUSIONS: The one-puncture technique of RSB combined with TAPB provides effective postoperative analgesia for laparoscopic upper abdominal surgery, reduces the incidence of EA during PACU, and promotes early recovery.
BACKGROUND: ChiCTR, ChiCTR2300067271. Registered 3 Jan 2023, http://www.chictr.org.cn .