腹腔镜引导腹横肌平面阻滞在腹腔镜胆囊切除术后的镇痛效果

目的 探讨腹腔镜引导腹横肌平面阻滞用于腹腔镜胆囊切除术后的镇痛效果.方法 选择腹腔镜胆囊切除手术常规全麻病人40例,用随机数字表法均分为两组,腹横肌平面阻滞(A组)与静脉镇痛组(B组).A组于术后行腹腔镜引导双侧腹横肌平面阻滞,分别注射0.25％罗哌卡因+5 mg?L-1肾上腺素30 mL同时静脉泵注生理盐水2 mL?h-1.B组同样行腹腔镜引导双侧腹横肌平面穿刺注射30 mL生理盐水而静脉泵注舒芬太尼100 μg/100 mL,2 mL?h-1,当视觉模拟评分(VAS)≥4分或病人需要时单次静注吗啡1 mg作镇痛补救.比较两组术后1、3、6、12、24 h的VAS评分;Ramsay镇静评分;首次吗啡使用时间，记录术后24 h单次静注吗啡次数、吗啡的总用量、镇痛满意度及不良反应发生率.结果 A组术后1、3、6、12 h的VAS评分均低于B组(P＜0.01),而24 h及Ramsay镇静评分差异无统计学意义.术后24 h吗啡的使用情况:A组和B组首次注射时间分别为(6.8±0.7) min vs (3.1±0.9) min(P＜0.01);补充次数(1.8±0.6)次 vs (3.2±0.8)次(P＜0.01);总用量(1.8±0.7) mg vs (3.1±0.7) mg(P＜0.01).镇痛满意度A组高于B组(96% vs 92%);B组发生恶心、呕吐5例，明显高于A组的1例;两组均无穿刺部位血肿、感染及皮肤瘙痒、呼吸抑制、尿潴留等不良反应的发生.结论 腹腔镜引导下腹横肌平面阻滞在腹腔镜胆囊切除术后能提供有效的镇痛,减少术后静脉镇痛药的需要量及不良反应发生率.

The analgesia effect of laparoscopic-guidance transverse abdominal plane block for laparoscopic cholecystectomy

Objective To investigate the analgesic efficacy of laparascopic-guidance transversus abdominis plane block(TAPB).Methods Forty adult patients undergoing laparoscopic cholecystectomy under standard general anesthesia were randomly assigned into TAPB group and PCIA group,which termed as group A and B.Group A was treated with bilateral laparascopic-guidance TAPB by using 0.25% ropivacaine plus 5 mg·L-1 epinephrine 30 mL on each side (60 mL in total) together with 100 mL continuous pump of saline infusion 2 mL·h-1(n=20).Group B was intravenous analgesia group,continuous pump of sufentanil 100 μg/100 mL,2 mL·h-1,also treated with bilateral laparascopic-guidance transversus abdominis plane block using 30 mL saline on each side (n=20).The visual analogue scale(VAS) of these two groups on 1,3,6,12 and 24 hours postoperation (demanding IV morphine 1 mg for remedy when the VAS≥4),Ramsay,record the time for first morphine use,the total number of single intravenous injection of morphine,total consumption,analgesia satisfaction and incidence of adverse reactions after 24 hours postoperation were compared.Results The scores of the VAS on 1,3,6,12 hours postoperation in the group A had significantly lower than group B (P<0.01),while scores on 24 hours showed no statistical significance (P>0.05).Also,Ramsay Sedation score had no statistically significant difference between two groups.The usage of the opioids in group A was lower (P<0.01) than that in group B.The first time injection in group A and group B were [(6.8±0.7) min vs (3.1±0.9) min,P<0.01];Supplementary time [(1.8±0.6)second vs (3.2±0.8) second(P<0.01)];Total dosage [(1.8±0.7) mg vs (3.1±0.7) mg (P<0.01)].There were five nausea and 1 vomiting cases in group B,which is significantly higher than that in group A (only 1 cases was recorded).No puncture site hematoma,infection,skin itching,respiratory depression,urinary retention and other adverse reactions occurred in both groups.The analgesia satisfaction rate for group A and B are 96% and 92%.Conclusions Transversus abdominis plane blocks could significantly decrease the usage of opioid(morphine) in short time and pain adverse effect.