不同时点腹横肌平面阻滞对腹腔镜术中及术后镇痛效果的影响

目的 比较术前和术后腹横肌平面阻滞(transversus abdominis plane,TAP)对腹腔镜手术患者术中和术后镇痛效果的影响. 方法 全身麻醉下行腹腔镜肠道手术的患者120例,采用随机数字表法分为切皮前处理组(A组)、缝皮后处理组(F组)和对照组(C组),每组40例.A组和F组患者分别在切皮前和手术后进行B超引导下TAP阻滞,分别给予双侧注射0.4％罗哌卡因各20 ml;C组患者则给予等量生理盐水.所有患者术后均使用芬太尼静脉输注自控镇痛泵.比较3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、48 h芬太尼用量,VAS评分和副作用等. 结果 3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).术中A组瑞芬太尼用量[(1.01±0.10) mg]小于F组[(1.40±0.30)mg]和C组[(1.38±0.30)mg](P＜0.05);术后3、6、12、24 h时,A组和F组患者静息与咳嗽状态下VAS评分低于C组(P＜0.05),术后30 h时,F组患者静息与咳嗽状态下VAS评分低于A组和C组(P＜0.05);术后3、6、12、24 h时,A组和F组的芬太尼用量少于C组(P＜0.05),且术后3h时,F组的芬太尼用量高于A组(P＜0.05),术后30 h时,F组的芬太尼用量少于A组和C组,差异有统计学意义(P＜0.05);3组术后恶心、呕吐等副作用比较,差异无统计学意义(P＞0.05). 结论 TAP的镇痛作用与局部麻醉药阻滞作用时间相关联.术前或术后TAP在镇痛作用上差异无统计学意义.

The influence of transversus abdominis plane on intraoperative and postoperative analgesia at different time points in the abdomen laparoscopy operations

Objective Comparing the influence of transversus abdominis plane (TAP) block on intraoperative and postoperative analgesia at different time points in the abdomen laparoscopy operations.Methods One hundred and twenty patients undergoing abdomen laparoscopy under general anesthesia were allocated randomly to receive TAP block with 0.4％ ropivacaine 20 ml each side,either pre-incisional(group A),or at the end of surgery(group F) or sham block(saline,group C)(n=40).Hemodynamic parameters during skin incision,peri-operative analgesic requirements,the amount of postoperative fentanyl and the side effects were recorded.Pain was evaluated postoperatively both at coughing and at rest by visual analogue scale at 3,6,12,24,30,48 h after operation.Results Hemodynamic parameters among three groups were compared.Compared with that in group F [(1.40±0.30) mg] and that in group C [(1.38±0.30) mg],the dose of using remifentanyl in group A [(1.01±0.10) mg] was significantly reduced (P＜0.05).Compared with scores at correspondent time points at 3,6,12 h and 24 h post operation in the control group(group C) both at rest and at coughing conditions,pain scores were significant reduced in the TAP block group (group A and group F)(P＜0.05).VAS scores were significantly lower in group F than those in group A both at rest and at coughing conditions at 30 h after operation(P＜0.05).Compared with doses used in the control group (group C) at 3,6,12 h and 24 h post operation (P＜0.05),the doses of fentanyl used were significantly reduced in the TAP block group(group A and group F).Compared with that in group A(P＜0.05) at 3 h post operation,the dose of fentanvl used was significantly increased in group F.The usage of fentanyl was lower in group F than those in group A and group C (P＜0.05).Incidences of postoperative nausea and vomiting were no significant different.Conclusions Our results suggest that TAP block is related with the acting time of local analgesic and no significant difference on analgesic effects of TAP block either with pre-incisional TAP block or with TAP block at the end of operation.