腹横肌平面阻滞减轻袖状胃切除患者术后急性疼痛及预防术后慢性疼痛

目的研究腹横肌平面（TAP）阻滞对减重患者术后急性疼痛、术后慢性疼痛（CPSP）以及术后恢复的作用。 方法选择2019年11月至2020年11月于安徽医科大学第二附属医院行腹腔镜袖状胃切除术（LSG）的肥胖症患者，按麻醉方法不同随机分为全麻组（GA组）和全麻联合腹横肌平面阻滞组（TAP组），每组各75例。比较两组术后1 h、6 h、12 h、24 h的视觉模拟评分（VAS）、术后48 h内镇痛泵有效按压次数、术后病房补救镇痛发生率、术后恶心、呕吐发生率、术后3 d PSQI评分和术后3、6个月CPSP发生率。其中CPSP数据通过电话随访获取。 结果与GA组相比，TAP组术后1 h、6 h、12 h、24 h的VAS评分明显降低，术后48 h内镇痛泵有效按压次数及术后病房补救镇痛发生率明显减少，PONV发生率明显降低，术后3 d PSQI评分明显降低（P<0.05）。TAP组术后3、6个月CPSP发生率明显低于GA组（P<0.05）。 结论TAP阻滞运用于减重手术可以有效地减轻术后急性疼痛，减少阿片类药物用量，改善术后睡眠质量。TAP阻滞可能预防减重患者术后慢性疼痛的发生。

Transversus abdominis plane block reduce postoperative acute pain and prevents chronic post-surgical pain after sleeve gastrectomy.

ObjectiveTo study the effect of transversus abdominal plane (TAP) block on acute postoperative pain, chronic post-surgical pain (CPSP) and postoperative recovery of weight loss patients. MethodsLaparoscopic sleeve gastrectomy was performed in the Second Affiliated Hospital of Anhui Medical University from November 2019 to November 2020. The patients were randomly divided into general anesthesia group (GA group) and general anesthesia combined with transverse abdominal muscle plane block group (TAP group), with 75 cases in each group. The visual analogue Scale (VAS), effective pressure times of analgesia pump within 48 hours after operation, incidence of remedial analgesia in postoperative ward, post-operative nausea and number of vomiting (PONV), Pittsburgh sleep quality index (PSQI) score 3 days after operation and CPSP incidence 3 and 6 months after operation were compared between the two groups. Among them, CPSP data were obtained by telephone follow-up. ResultsCompared with GA group, VAS scores in TAP group decreased significantly at 1, 6, 12, 24 hours after operation, the effective times of analgesia pump and the incidence of remedial analgesia in postoperative ward decreased significantly within 48 hours after operation, and the incidence of PONV decreased significantly after operation. The 3 days after operation PSQI score decreased significantly (P<0.05). The incidence of CPSP in TAP group was significantly lower than that in GA group at 3 and 6 months after operation (P<0.05). ConclusionsTAP block can effectively reduce postoperative acute pain, reduce the dosage of opioids, improve postoperative sleep quality. TAP block may prevent postoperative chronic pain in patients with weight loss.