Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: a cadaveric study

Ultrasound-guided transversus abdominis plane (TAP) block can be performed using a subcostal technique. This technique was simulated using dye injection in cadavers in order to determine segmental nerve involvement and spread of injectate using either single or multiple-injection techniques. Dye most commonly spread to affect T9 and T10 nerves with the single injection technique and T9, T10 and T11 with multiple injections. The median (IQR [range]) spread of dye was 60 (36–63 [32–78]) cm² using the single-injection technique and 90 (85–96 [72–136]) cm², in the multiple-injection technique, and this difference was statistically significant (p = 0.003). These results indicate that ultrasound-guided subcostal TAP block will involve nerve roots T9, T10 and T11 and that a multiple-injection technique may block more segmental nerves and increase spread of injectate.     

Subcostal transversus abdominis plane block for postoperative analgesia in liver transplant recipients

Background

Postoperative pain treatment in orthotopic liver transplant (OLT) patients is a challenge. We performed a pilot study on ultrasound-guided transversus abdominis plane (TAP) block in OLT patients. To test the efficacy of this technique, which is noveI to OLT patients, we compared morphine consumption, pain scores, and time to extubation with a matching control group.

Methods

Seventeen patients who underwent OLT underwent bilateral ultrasound-guided TAP block using a subcostal approach with levobupivacaine (0.5%; 20 mL each) followed by postoperative morphine patient-controlled analgesia (PCA). The control group of 17 patients had only morphine PCA. We recorded the total morphine consumption, postoperative pain, and time to extubation.

Results

The total amount of morphine consumption over 24 hours was 45.9 ± 33.9 mg in the TAP group and 71.8 ± 39.9 mg in the control group (P < .005). Median pain scores were 1 in the TAP group and 2 in the control group (not significant [NS]). Median time to extubation was 60 minutes in the TAP group and 97 minutes in the control group (P = NS).

Conclusion

Initial evaluation of subcostal TAP block after OLT showed significant reduction in postoperative morphine consumption.     

腰方肌阻滞与肋缘下腹横肌平面阻滞在腹腔镜胃癌根治术后镇痛效果的比较

目的:比较超声引导下腰方肌阻滞（quadratus lumborum block, QLB）与肋缘下腹横肌平面阻滞（transverse abdominal plane block, TAPB）用于腹腔镜胃癌根治术的术后镇痛效果。方法:选择2021年1月至2021年7月择期在全身麻醉下行腹腔镜胃癌根治术的患者60例,采...     

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.     

腹横肌平面阻滞用于剖宫产术后镇痛的效果评价:Meta分析

目的 采用Meta分析的方法评价腹横肌平面阻滞(transversus abdominis plane block,TAPB)在剖宫产术后镇痛的安全性及有效性. 方法 检索PubMed 、OVID、EMBASE、Cochrane图书馆,检索时间从建库至2015年3月.收集剖宫产术后镇痛使用TAPB的随机对照临床试验.采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan5.2软件进行Meta分析. 结果 共纳入12项研究,包括663例患者,其中TAPB组342例,对照组321例.与对照组比较,TAPB组患者术后12h活动时VAS评分明显降低[加权均数差(weighted mean difference,WMD)=-0.61,95％置信区间(confidence interval,CI):-1.13～-0.09,P＜0.05]、术后24 h吗啡累积消耗量减少(WMD=-22.78,95％CI:-24.49～-21.07,P＜0.05)以及TAPB组患者需首次给予补救镇痛的时间延长(WMD=148.22,95％CI:86.57～209.86,P＜0.05),并且TAPB组患者恶心呕吐[比值比(OR)=0.23,95％CI:0.12～0.44,P＜0.05]及过度镇静(OR=0.29,95％CI:0.12～0.67,P＜0.05)的发生率较低. 结论 TAPB可能是剖宫产患者术后镇痛的一种较好的选择.     

不同浓度罗哌卡因腹横肌平面阻滞用于剖宫产术后镇痛的效果

目的探讨不同浓度罗哌卡因腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产术后镇痛的效果。方法选择ASAⅠ或Ⅱ级剖宫产产妇150例,随机均分为三组:A组、B组和C组术后双侧TAP分别注射0.25%、0.20%、0.15%罗哌卡因1.5mg/kg,并使用PCIA。观察和记录术后4、8、12、24和48h产妇VAS评分。并记录产妇镇痛满意率、镇痛泵按压次数及发生TAP相关并发症(穿破腹膜入腹腔、腹壁严重损伤、感染出血、局麻药误入血管及局麻药中毒)。结果与C组比较,术后不同时点A组产妇VAS评分明显降低(P0.05)。术后不同时点A组和B组VAS评分差异无统计学意义。与C组比较,A组和B两组产妇对镇痛满意率明显增加、镇痛泵按压次数明显减少(P0.05)。三组产妇未发生穿破腹膜入腹腔、腹壁严重损伤、感染出血、局麻药误入血管及局麻药中毒等TAP相关并发症。结论 0.20%以上罗哌卡因TAP阻滞联合PCIA用于剖宫产术后镇痛是安全有效的。     

腰方肌阻滞与腹横肌平面阻滞用于成人腹部手术术后镇痛效果的Meta分析

目的评价超声引导下腰方肌阻滞(QLB)与腹横肌平面阻滞(TAPB)在成人腹部手术术后镇痛的效果。方法检索Cochrane、Pubmed、Embase、中国知网、万方和维普数据库,纳入腰方肌阻滞(QLB组)与腹横肌平面阻滞(TAP组)在成人腹部手术后镇痛比较的随机对照试验(RCT)。主要结局指标为术后VAS疼痛评分,次要结局指标包括术后24 h内补救性镇痛率及术后不良反应发生率。采用RevMan 5.3进行Meta分析。结果最终纳入19项RCTs,共1412例患者。与TAP组比较,QLB组术后8 h静息(MD=-0.29, 95%CI-0.52～-0.06,P0.05)及运动状态(MD=-0.47, 95%CI-0.80～-0.14,P0.05)和12h静息(MD=-0.30,95%CI-0.48～-0.13,P0.05)及运动状态(MD=-0.68, 95%CI-1.03～-0.33,P0.05)时VAS评分均明显降低。QLB组术后24 h内补救性镇痛率明显低于TAP组(RR=0.27, 95%CI 0.17～0.42,P0.05),同时恶心呕吐、眩晕的发生率明显低于TAP组(RR=0.37, 95%CI 0.24～0.56,P0.05; RR=0.29, 95%CI 0.14～0.57,P0.05)。结论腰方肌阻滞用于成人腹部手术术后镇痛效果优于腹横肌平面阻滞,且不良反应更少。     

Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery

Subcostal transversus abdominis plane (TAP) catheters have been reported to be an effective method of providing analgesia after upper abdominal surgery. We compared their analgesic efficacy with that of epidural analgesia after major upper abdominal surgery in a randomised controlled trial. Adult patients undergoing elective open hepatobiliary or renal surgery were randomly allocated to receive subcostal TAP catheters (n=29) or epidural analgesia (n=33), in addition to a standard postoperative analgesic regimen comprising of regular paracetamol and tramadol as required. The TAP group patients received bilateral subcostal TAP catheters and 1 mg.kg(-1) bupivacaine 0.375% bilaterally every 8 h. The epidural group patients received an infusion of bupivacaine 0.125% with fentanyl 2 μg.ml(-1) . The primary outcome measure was visual analogue pain scores during coughing at 8, 24, 48 and 72 h after surgery. We found no significant differences in median (IQR [range]) visual analogue scores during coughing at 8 h between the TAP group (4.0 (2.3-6.0 [0-7.5])) and epidural group (4.0 (2.5-5.3) [0-8.5])) and at 72 h (2.0 (0.8-4.0 [0-5]) and 2.5 (1.0-5.0 [0-6]), respectively). Tramadol consumption was significantly greater in the TAP group (p=0.002). Subcostal TAP catheter boluses may be an effective alternative to epidural infusions for providing postoperative analgesia after upper abdominal surgery.     

超声引导下多点肋缘下腹横肌平面阻滞在开腹胃癌根治术中的应用

目的观察双侧多点肋缘下腹横肌平面阻滞(transversus abdominis plane block,TAP)对开腹胃癌根治术患者术后镇痛效果的影响。方法择期全麻下行开腹胃癌根治术患者60例,男35例,女25例,年龄50~70岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。全麻诱导成功后,超声引导下行双侧肋缘下多点腹横肌平面阻滞,两组患者分别注入0.5%罗派卡因40ml(研究组)或等量生理盐水(对照组)。手术结束患者清醒拔管后被推入PACU,患者离开PACU之前连接静脉自控镇痛泵。记录拔管后2、6、12、24和48h的疼痛VAS评分,记录术中舒芬太尼、瑞芬太尼及血管活性药物的总用量,术后镇痛泵按压次数及舒芬太尼的总用量。结果术后6、12、24h,研究组VAS评分明显低于对照组(P0.05)。研究组术中舒芬太尼、瑞芬太尼和血管活性药物的总用量,术后镇痛泵按压次数,及术后舒芬太尼的总用量均明显少于对照组(P0.05)。结论腹横肌平面阻滞通过阻滞前腹壁腹横肌平面的周围神经,为开腹胃癌根治术患者提供良好的术后镇痛。     

腹横肌平面阻滞在腹部手术术后镇痛中的应用

背景 腹横肌平面（transversus abdominis plane block,TAP）阻滞技术是一项近几十年发展起来的新型的局部神经阻滞技术,它可以减少术后镇痛阿片类药物的用量,继而减少其相关副作用,提高患者总的满意度. 目的 介绍TAP阻滞技术,探讨其在腹部手术术后镇痛中的应用. 内容 就TAP阻滞的解剖基础、操作方法、临床效果、并发症及尚待解决的问题等方面进行综述,为临床研究及应用提供参考. 趋向 TAP阻滞技术,被证实在很多手术的术后镇痛应用中是安全、有效的,有着广阔的应用前景.     

The analgesic efficacy of transversus abdominis plane (TAP) block

The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. It was described for the first time in 2007 by McDonnell et al. We applied the technique after the original methodology of the authors. We evaluated its analgesic efficacy first 24 postoperative hours of patients, undergoing to surgical and urological interventions. After induction of anesthesia, 20 ml of 0.375% levobupivacaine was deposited into the transversus abdominis neuro-fascial plane via the bilateral lumbar triangles of Petit. Each patient was evaluated by VAS in the postanesthesia care unit at the 2, 4, 6, 12 and 24 h postoperatively. Despite the results were more unsatisfactory than those of McDonnel, they were good. Our first impression is that the TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery.     

Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors: A prospective,randomized, double-blinded clinical trial

BackgroundTransversus abdominis plane (TAP) block is a peripheral nerve block that reduces postoperative pain, nausea, vomiting and the need for postoperative opioids following various types of abdominal surgery. The primary aim of the present study was to evaluate the effects of TAP block on postoperative analgesia and opioid consumption in living liver donors in whom a right “J” abdominal incision was used.MethodsThis prospective, double-blinded, randomized controlled study was conducted with 50 living liver donors, aged 18–65 years, who were scheduled to undergo right hepatectomy. Patients who received ultrasonography-guided subcostal TAP block were allocated into Group 1, and patients who did not receive TAP block were allocated into Group 2. The TAP blocks were performed bilaterally at the conclusion of surgery using 1.5 mg 1 kg^− 1 bupivacaine diluted with saline to reach a total volume of 40 mL. For each patient, morphine consumption, pain scores at rest and movement, sedation scores, nausea, vomiting and the need for antiemetic medication were assessed at 0, 2, 4, 6, 12 and 24 h postoperatively by researchers who were blinded to the study groups.ResultsMorphine consumption was significantly lower in Group 1 than in Group 2 at the 2nd, 6th and 24th hours (P < 0.05). The mean total morphine consumption values after 24 h were 40 mg and 65 mg in Groups 1 and 2, respectively. The TAP block significantly reduced postoperative visual analog scale pain scores both at rest and during movement at 0, 2, 4, 6, and 24 h postoperatively (P < 0.05).ConclusionsThe TAP block reduced 24-h postoperative morphine consumption and contributed to analgesia in living liver donors who underwent upper abdominal wall incisions.     

连续与单次腹横肌平面阻滞用于腹腔镜胆囊切除术后镇痛的效果比较

目的比较连续腹横肌平面阻滞(CTAPB)与单次腹横肌平面阻滞(STAPB)用于腹腔镜下胆囊切除术(LC)的术后镇痛效果。方法纳入拟行LC患者90例,分成对照组、S组和C组,每组30例,S组和C组患者气管插管后分别行STAPB和CTAPB,术毕三组患者均行患者自控静脉镇痛(PCIA),记录三组患者术后1,6,12,24,48,72 h切口部位及腹部深处疼痛视觉模拟(VAS)评分,术后72 h内PCIA镇痛泵按压次数,术后麻醉不良反应发生情况和术后镇痛的满意度。结果 S组和C组患者术后1、6和12 h切口部位和腹部深处VAS评分均显著低于对照组患者(P0.05),S组和对照组患者术后24、48和72 h切口部位和腹部深处VAS评分差异无统计学意义(P0.05),C组患者术后24、48和72 h切口部位和腹部深处VAS评分显著低于S组和对照组患者(P0.05)。术后72 h内S组和C组患者PCIA按压次数均显著少于对照组患者(P0.05),C组患者术后PCIA镇痛泵按压次数显著少于S组患者(P0.05)。S组和C组患者术后恶心发生率均低于对照组患者(P0.05)。术后S组和C组患者满意度均高于对照组患者(P0.05),C组患者满意度高于S组患者(P0.05)。结论超声引导下CTAPB可有效增强LC术后患者的镇痛效果,减少患者阿片类药物使用,降低阿片类药物不良反应发生率,提高患者术后满意度,可作为LC术后较为理想的镇痛方式。