腹横肌平面阻滞在腹式全子宫切除术中的应用经验

目的探讨腹横肌平面阻滞(TAP)技术在腹式全子宫切除术中的应用。方法选择择期行开腹全子宫切除术患者50例,分为两组(n=25),腹横肌平面阻滞组(TAP组)和对照组。TAP组患者在全麻插管后实施B超引导下双侧腹横肌平面阻滞,对照组患者不行阻滞,两组患者术后均采用相同静脉自控镇痛方案。比较两组患者术后各项监测指标的差异。结果 TAP组患者术毕清醒时间,术后VAS疼痛评分、排气时间、早期下床时间、出院时间均较对照组显著降低。结论腹横肌平面阻滞(TAP)技术在开腹全子宫切除术中能使患者早期苏醒,减少术后疼痛,提早下床活动及减少住院时间等作用,有益于患者术后快速康复。     

超声引导腹横肌平面阻滞在结直肠癌手术中的应用

目的观察超声引导下腹横肌平面（transversus abdominis plane,TAP）阻滞用于结直肠癌手术患者术中及术后的镇痛效果。方法 32例全麻下行结直肠癌手术患者随机均分为两组。于全麻诱导后手术前在超声引导下双侧TAP分别注射0.375%罗哌卡因12～15ml（R组）或等量生理盐水（S组）。所有患者术后均使用静脉自控镇痛泵。比较两组术中切皮反应、芬太尼用量及术后2、6、12、24、48h VAS评分,记录术后镇痛泵按压次数、镇痛满意度及相关并发症。结果与S组相比,R组切皮时BP、HR变化明显减小（P〈0.05或P〈0.01）。两组镇痛效果良好,且R组术后2、6、12h的VAS评分均低于S组（P〈0.05）。R组镇痛泵按压次数减少（P〈0.05）。两组均未见TAP穿刺引起的不良反应。结论超声引导下的TAP阻滞定位准确,操作成功率高,用于结直肠癌手术能有效镇痛,明显减少术中及术后静脉镇痛药的需要量。     

腹横肌平面阻滞用于剖宫产术后镇痛

目的 观察腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产手术后的镇痛效果.方法 30例腰麻下行剖宫产手术产妇随机均分为两组.术后双侧TAP分别注射0.375%罗哌卡因1.5 mg/kg(R组)或等量生理盐水(S组).所有产妇均使用静脉自控镇痛泵.比较两组术后2、6、12和24 h视觉模拟疼痛(VAS)评分,镇痛泵按压次数和镇痛满意度.结果 两组产妇不同时点的VAS评分差异无统计学意义.与S组相比.R组镇痛泵按压次数减少(P＜0.05),镇痛满意度较好(P＜0.05).两组均未见TAP穿刺引起的不良反应.结论 TAP阻滞用于剖宫产手术后镇痛能明显减少静脉镇痛药的需要量.     

超声引导腹横肌平面阻滞技术对小儿腹股沟疝术后早期镇痛效果的研究

目的评价超声引导腹横肌平面阻滞技术在小儿腹股沟疝术后早期镇痛治疗的效果。方法选取十堰市妇幼保健院3~7岁行单侧腹股沟疝手术的患儿82例,随机分为TAP组和局部浸润组,各41例。TAP组患儿术前采用0.25%左旋布比卡因0.5 ml/kg行腹横肌平面阻滞技术(TAP),局部浸润组患儿采用0.25%左旋布比卡因0.2 ml/kg术前行伤口浸润,观察两组患者术后第1,2,4,8,12,16,20,24 h的Eastern Ontario儿童医院疼痛评分、首次补救镇痛时间、术后24 h累计补救镇痛药物使用次数和量、副反应恶心和呕吐的率。结果 TAP组患儿的疼痛评分除第1,20,24 h外均低于局部浸润组(P0.05),TAP组患儿首次补救镇痛时间较局部浸润组显著延长(P0.05),术后24 h累计补救镇痛药物使用次数和量均低于局部浸润组(P0.05),副反应恶心和呕吐率两组无明显差异(P0.05)。结论超声引导下TAP阻滞技术在小儿腹股沟疝术后早期有良好的镇痛效果,可以减轻患儿疼痛程度,减少止痛药物使用量,是一种安全有效的镇痛技术。     

腹横肌平面阻滞对阑尾切除术术后镇痛及患者恢复情况的影响

目的观察腹横平面(transversus abdominis plane,TAP)阻滞对阑尾切除术术后镇痛及患者恢复情况的影响。方法选择行阑尾切除术患者40例,ASAⅠ或Ⅱ级,随机均分为:TAP阻滞组和对照组,术后1h内在B超定位下行单侧TAP阻滞,两组分别注射0.25%罗哌卡因20ml、生理盐水20ml。观察并记录患者术后4h(T0)、8h(T1)、12h(T2)、24h(T3)、48h(T4)时疼痛VAS评分;记录术后48h内满意度VAS评分和需追加哌替啶的例数。患者胃肠道恢复时间、下床时间及该阻滞腹部脏器损伤、穿刺部位感染等并发症的发生。结果与对照组比较,T0~T2时TAP阻滞组疼痛VAS评分明显降低(P0.05)。术后48h内TAP阻滞组追加哌替啶的例数明显少于对照组。两组患者术后胃肠道恢复时间和下床时间差异均无统计学意义。与对照组比较,TAP阻滞组患者需追加哌替啶例数明显减少、满意度明显升高(P0.05)。无一例患者发生腹部脏器损伤、穿刺部位感染等并发症。结论 TAP阻滞在阑尾切除术术后镇痛中,降低患者术后疼痛,减少术后镇痛药物需求,是一种安全有效的镇痛方式。     

超声引导腰方肌与腹横平面阻滞用于腹股沟区手术患儿术后镇痛效果的比较

目的 比较超声引导腰方肌阻滞(QL)与腹横平面阻滞(TAP)用于腹股沟区手术患儿术后的镇痛效果.方法 择期喉罩全麻下行单侧腹股沟区手术的男性患儿60例.年龄4～8岁,ASA分级Ⅰ～Ⅱ.按随机数字表法分为QL组和TAP组,每组30例.喉罩置入后在超声引导下QL组行外侧入路腰方肌阻滞,TAP组行腹横平面阻滞,2组均应用0....     

酒石酸布托啡诺复合超声引导腹横纹肌阻滞的应用观察

目的研究静注酒石酸布托啡诺复合超声引导下腹横肌平面(TAP)阻滞在妇科开腹手术中的应用效果,为后期治疗提供依据。方法选取本院收治的200例行妇科开腹手术患者,采用抛硬币的方法随机分为两组,每组各100例。两组均在完成手术后拔管前期,均在超声引导下双侧TAP分别注射0.375%罗哌卡因20ml,并注入酒石酸布托啡诺1mg(T组)及空白对照组(D组)。术后两组患者均使用静脉自控镇痛泵。比较两组拔管后心率血压变化,利用视觉模拟疼痛(VAS)评分评估两组患者术后2、6、12、24小时和48小时疼痛情况,利用医院自制的表格统计两组患者镇痛满意度,记录术后各类并发症。结果正确的超声引导下,T组患者顺利完成TAP阻滞;T组切皮时血压、脉率变化小于D组,数据差异显著(P0.05);T组患者术后2、6、12小时的VAS评分低于D组(P0.05),术后24及48小时VAS评分差异不显著,统计学分析比较不具有实际意义(P0.05);T组镇痛泵按压次数减少(P0.05),镇痛满意度较好(P0.05)。T组均未见TAP穿刺引起的不良反应。结论酒石酸布托啡诺复合超声引导下腹横肌平面(TAP)阻滞在妇科开腹手术中应用能够有效缓解疼痛,减少静脉阵痛类药物在术中以及术后的用量,阵痛效果显著,操作成功率较高,值得临床推广。     

后路与肋缘下腹横肌平面阻滞应用于下腹正中纵切口剖宫产术后镇痛的比较

目的 比较后路与肋缘下腹横肌平面(transversus abdominis plane,TAP)阻滞应用于下腹正中纵切口剖宫产术后镇痛效果.方法 选取行剖宫产术,ASA分级Ⅰ、Ⅱ级产妇100例,用随机数字表法分为A组和B组,每组50例.两组产妇均在蛛网膜下腔-硬膜外腔联合麻醉下行腹部正中纵切口剖宫产手术,待手术结束之后超声引导下进行双侧TAP阻滞,A组产妇采用后路TAP阻滞,B组产妇采用肋缘下TAP阻滞,两侧腹壁分别给予0.375％罗哌卡因20 ml.观察两组产妇术后2、6、12、24 h静息及运动时VAS评分及两组患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)术后24 h按压泵次数、布托啡诺术后24 h用量、镇痛满意度,同时观察比较两组产妇术后镇痛相关副作用的发生情况.结果 A组产妇术后2、6、12h运动VAS评分[(0.8±1.0)、(2.1±0.9)、(2.0±0.9)分]明显低于B组[(1.8±1.4)、(4.3±1.9)、(4.6±2.2)分](P＜0.05);A组产妇PCIA术后24 h按压泵次数、布托啡诺术后24 h用量也明显少于B组(P＜0.05);满意度高于B组(P＜0.05).在术后镇痛相关副作用方面,A组瘙痒、呕吐发生明显少于B组(P＜0.05),两组均无呼吸抑制、局部血肿及局部麻醉药中毒发生.结论 与肋缘下TAP阻滞比较,经后路TAP阻滞结合PCIA对下腹部正中纵切口剖宫产术后镇痛更为有效,术后阿片药使用剂量更小、副作用更少.     

腹腔镜辅助腹横肌平面阻滞技术临床应用进展

腹横肌平面(TAP)阻滞技术在腹部手术中的应用经历了一个复杂的阶梯式的发展过程,由外科医生主导的腹腔镜辅助腹横肌平面阻滞(Lap-TAP)是近年来国际上一种新兴的围手术期镇痛方式,逐渐被临床推广应用.与超声引导下TAP阻滞技术相比,Lap-TAP可在腹腔镜直视侧腹壁下,由外科医师独立完成操作,无需麻醉科医师及超声设备,...     

腹腔镜直肠癌术中应用腹横筋膜阻滞与镇痛泵的效果对比

目的:比较腹横肌平面(transversus abdominis plane,TAP)阻滞与患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)在腹腔镜辅助直肠癌根治骶前吻合术后的镇痛效果。方法:连续选取42例行腹腔镜辅助直肠癌根治骶前吻合术的患者,随机分为TAP组与PCIA组,每组21例。记录两组年龄、性别、手术方式、手术时间、术中出血量、术后肿瘤分期、术后近期并发症(14 d内)、首次下床时间、首次排气时间及不同时间点的疼痛评分。结果:两组患者年龄、性别、肿瘤分期、手术时间、术中出血量、术后并发症、首次下床时间差异无统计学意义; TAP组术后首次排气时间[(50.0±12.7) h vs.(60.2±13.3) h]优于PCIA组。两因素重复测量方差分析显示,TAP组疼痛评分较PCIA组低0.444(95%CI:-0.816～-0.73,P0.05)。结论:腹腔镜辅助直肠癌根治骶前吻合术中采用TAP阻滞具有较好的镇痛作用,与PCIA相比减少了对肠道的抑制作用,加速了患者的恢复。     

Clinical implications of the transversus abdominis plane block in pediatric anesthesia

Optimal perioperative analgesia for infants and children after major abdominal surgery poses a challenge when central neuraxial techniques are contraindicated. As a regional anesthesia technique, the transversus abdominis plane (TAP) block has been shown to reduce opioid consumption and improve pain scores compared to traditional perioperative pain strategies. Accordingly, TAP blocks may be considered as an alternative to central neuraxial analgesia to optimize perioperative pain control. Advancements in ultrasound technology have further improved the reliability and safety profile of this technique. Despite growing recognition of the diverse clinical scenarios where TAP blocks may be of benefit, its use among pediatric anesthesiologists remains limited. This article describes the history, anatomy, and a review of the current literature on TAP blocks with an emphasis on outcomes in pediatric patients.     

The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review

The transversus abdominis plane (TAP) block is a newly described peripheral block involving the nerves of the anterior abdominal wall. The block has been developed for post‐operative pain control after gynaecologic and abdominal surgery. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound‐guided access to the neurovascular plane via the mid‐axillary line between the iliac crest and the costal margin, and a subcostal access termed the ‘oblique subcostal’ access. A systematic search of the literature identified a total of seven randomized clinical trials investigating the effect of TAP block on post‐operative pain, including a total of 364 patients, of whom 180 received TAP blockade. The surgical procedures included large bowel resection with a midline abdominal incision, caesarean delivery via the Pfannenstiel incision, abdominal hysterectomy via a transverse lower abdominal wall incision, open appendectomy and laparoscopic cholecystectomy. Overall, the results are encouraging and most studies have demonstrated clinically significant reductions of post‐operative opioid requirements and pain, as well as some effects on opioid‐related side effects (sedation and post‐operative nausea and vomiting). Further studies are warranted to support the findings of the primary published trials and to establish general recommendations for the use of a TAP block.     

Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta‐analysis

Aim Reduced opioid use in the immediate postoperative period is associated with decreased complications. This study aimed to determine the effect of transversus abdominis plane (TAP) block on morphine requirements 24 h after abdominal surgery. Secondary outcomes included the effect of TAP block on morphine use 48 h after surgery, incidence of postoperative nausea and vomiting (PONV) and impact on reported pain scores (visual analogue scale). Method A systematic review of the literature was conducted for randomised controlled trials (RCTs) evaluating the effects of TAP block in adults undergoing abdominal surgery. For continuous data, weighted mean differences (WMD) were formulated; for dichotomous data, odds ratios (OR) were calculated. Results were produced with a random effects model with 95% confidence intervals (CI). Results Nine studies, including published and unpublished data, containing a total of 413 patients were included. Of these 205 received a TAP block and 208 a placebo. Cumulative morphine utilization was statistically significantly reduced at 24 h. [WMD = 23.71 mg (38.66–8.76); P = 0.002] and 48 h [WMD = 38.08 mg (18.97–57.19); P < 0.0001] in patients who received a TAP block and the incidence of PONV was significantly reduced [OR = 0.41(0.22–0.74); P = 0.003]. There was a nonsignificant reduction in the visual analogue scales of postoperative pain [WMD = 0.73 cm (1.84–0.38), P = 0.2]. There were no reported adverse events following TAP block. Conclusion Transversus abdominis plane block is safe, reduces postoperative morphine requirements, nausea and vomiting and possibly the severity of pain after abdominal surgery. It should be considered as part of a multimodal approach to anaesthesia and enhanced recovery in patients undergoing abdominal surgery.     

„Transversus-abdominis-plane“-Blockade

The transversus abdominis plane (TAP) block is a well known method for postoperative pain control after abdominal surgery. From an anatomical and physiological point of view it should be possible to perform abdominal wall surgery, e.g. wound debridement, using a TAP block only. To the authors knowledge no studies have been published with respect to the use of TAP only. This article presents a case report demonstrating that it is possible to perform three consecutive operation procedures within 7 days using only a bilateral TAP catheter technique. The TAP block without any co-medication provides high patient comfort and should be recognized as a good alternative for abdominal wall surgery.     

Comparison between the analgesic efficacy of transversus abdominis plane (TAP) block and placebo in open retropubic radical prostatectomy: a prospective,randomized, double-blinded study

Study ObjectiveTo compare the efficacy of ultrasound-guided tansversus abdominis plane (TAP) block with placebo for postoperative analgesia after retropubic radical prostatectomy (RRP).DesignProspective, randomized, double-blinded study.SettingTertiary-care Veterans Affairs (VA) hospital.PatientsASA physical status 1, 2, and 3 patients scheduled for RRP.InterventionsPatients were randomized to two groups: the TAP group and the control group. All patients underwent an ultrasound-guided TAP block procedure after induction of general anesthesia and received either local anesthetic (TAP group) or normal saline (control group).MeasurementsOpioid use and verbal analog pain scores at 1, 6, 12, and 24 hours after surgery were recorded, as was the frequency of side effects. Times to ambulation and first oral intake also were recorded.Main ResultsThe TAP block group had lower pain scores and required less total opioid in the first 24 hours after surgery. Time to first oral intake and time to ambulation were similar between the two groups.ConclusionThe TAP block has early benefits in postoperative analgesia after RRP.     

Analgésie postopératoire par voie locorégionale chez l'adulte: techniques perimédullaires et périphériques. Indications,effets indésirables et surveillance

Regional analgesia is a very effective way to treat postoperative pain. Lumbar and thoracic epidural analgesia are well adapted to major abdominal and thoracic surgery. Nevertheless, respiratory side effects induced by opioids are potentially severe and an adequate monitoring is essential. In orthopaedic surgery, perineural blocks are the best technique to manage postoperative pain and perineural catheters may be used. The importance of intra-articular analgesia, simple and safe, is not fully understood. The association of a local anaesthetic inducing a minor motor block and a strong sensitive block (bupivacaine, ropivacaine), with an opioid seems to be the best pharmacologic choice regarding quality of analgesia and safety. Benefits of postoperative regional analgesia on mortality and morbidity are not demonstrated. Medical and nursing staff and specialized units should improve quality of postoperative regional analgesia as well. General guidelines for the practice of regional anaesthesia must be closely followed.     

Ultrasound-guided quadratus lumborum and subcostal transversus abdominis plane blocks

Abdominal field blocks are commonly used for postoperative analgesia in major abdominal surgeries. The original transversus abdominis plane (TAP) block is limited in its dermatomal coverage to T10-L1. However, modifications made to the classic TAP block technique can enhance the spread of local anesthetic and provide more effective analgesia. In this article, we describe 2 of such modifications of the classic TAP block, namely quadratus lumborum and subcostal TAP blocks.     

Transversus abdominis plane (TAP) blocks—A review

IntroductionEffective post-operative pain management can positively influence patient outcome. Multimodal analgesic regimes are often limited by side-effects. Epidural analgesia may be resource-consuming, restrict mobility and have negative cardiovascular and gastrointestinal consequences. Consequently, there is a need for regional anaesthetic techniques to minimise opioid use, and provide alternatives to epidurals, especially within the context of minimally invasive abdominal surgery and enhanced recovery programmes. This review aims to evaluate the evidence base underlying Transversus abdominis plane (TAP) blockade.MethodsA literature search was performed using the PubMed database (http://www.ncbi.nlm.nih.gov/pubmed/) using the parameters ‘transversus abdominis plane’ and ‘TAP’. The references within were then searched for applicable studies. Case reports and correspondence were excluded.FindingsThirteen studies assessed technique and mechanisms of action. Fourteen clinical studies involved a total of 1250 patients. Seven studies (6 Randomised Controlled Trials, RCTs) demonstrated reductions in post-operative morphine requirements (33.3%–73.1%). Five RCTs demonstrated concomitant improvements in pain scores. Five RCTs demonstrated reduced opioid side effects. The one study assessing functional outcome (a Prospective Controlled Trial, PCT) demonstrated earlier return of gastrointestinal function and hospital discharge.ConclusionThe limited evidence to date suggests that TAP blockade is an effective adjunct to multimodal post-operative analgesia following a range of abdominal surgical procedures. Whether TAP blocks are a viable alternative to epidural analgesia remains to be determined. However, it is likely that as this technique grows in popularity its role, particularly that in enhanced recovery programmes, will be better delineated and refined.