肋缘下腹横肌平面阻滞对胆道手术患者术后镇痛效果的影响

目的 观察全麻复合肋缘下腹横肌平面阻滞与单纯全麻对胆道手术患者术后镇痛效果的影响.方法 择期行胆道手术患者70例,随机分为全麻复合超声引导肋缘下腹横肌平面阻滞组(联合组35例)和全麻组35例.术后在恢复室给予静脉吗啡滴定至镇痛评分(VAS)≤3分后接静脉吗啡自控镇痛泵.记录术后VAS评分、镇静评分(Ramsay)、吗啡滴定用量、术后24h镇痛泵内吗啡总用量、不良反应及术后镇痛患者满意度.结果 联合组吗啡滴定量及术后24 h镇痛泵内吗啡总用量少于全麻组(P<0.01).患者术后12 h内VAS评分低于全麻组(P<0.05).联合组麻醉总体满意度高于全麻组(P<0.01).结论 胆道手术患者行超声引导肋缘下腹横肌平面阻滞可减少吗啡用量,降低术后疼痛,提高麻醉总体满意度.

Effects of general anesthesia combined with or without subcostal transversus abdominis plane block on postoperative analgesia for patients undergoing biliary tract surgery

Objective To evaluate the postoperative analgesic efficacy of subcostal transversus abdominis plane block on patients undergoing biliary tract surgery.Methods Seventy patients scheduled to undergo biliary tract surgery were randomized to receive standard general anesthetic either with(combined group,n=35) or without subcostal transversus abdominis plane block(n=35).Patients in both groups were given intravenous morphine titration in the post-anesthesia care unit until the visual analog scale(VAS) score was less than 3 and then received PCIA.VAS score,Ramsay sedation score,satisfaction score and incidence of side effects were recorded at 1,3,6,12,24 h after operation.Results The dose of morphine for titration and the total morphine in pump consumed was lower in the combined group(P<0.01).There were significantly lower VAS score and higer satisfaction of the patients in the combined group postoperatively(P<0.05).No significant difference in Ramsay score and cases of adverse events were found between the two groups(P>0.05).Conclusion Subcostal transversus abdominis plane block can reduce postoperative pain for patients undergoing biliary tract surgery and improve the total satisfaction for anesthesia.