Lee T H W, Barrington M J, Tran T M N, Wong D, Hebbard P D
Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Anaesth Intensive Care. 2010 May;38(3):452-60. doi: 10.1177/0310057X1003800307.
Transversus abdominis plane block provides postoperative analgesia following abdominal surgery by targeting thoracolumbar nerves between the internal oblique and transversus abdominis muscles. Posterior and subcostal approaches using ultrasound guidance have been described. However there have been inconsistent results in relation to the extent of the sensory block. This observational study evaluated the distributions of sensory block following either a posterior or subcostal approach and the quality of analgesia achieved. Following ethics committee approval, 50 patients undergoing minimally invasive and major abdominal surgery were recruited. A total of 81 transversus abdominis plane blocks were performed preoperatively under real-time ultrasound guidance. Postoperatively, patients received multimodal analgesia including morphine via patient-controlled pumps. Ninety-eight percent of patients had some degree of demonstrable sensory block and the dermatomal spread differed between posterior and subcostal approaches (P < 0.001). The posterior approach produced a median sensory block of three dermatomal segments (interquartile range 2 to 4), the most cephalad being T10 (interquartile range T9 to T10), while the subcostal approach blocked a median of four segments (interquartile range 3 to 5), the most cephalad being T8 (interquartile range T7 to T9, P < 0.001). Maximum dermatomal block distribution was observed at 30 minutes and usually regressed by 24 hours. Median cumulative morphine consumption was 40.8 mg (interquartile range 17 to 50 mg) at 24 hours. Median pain scores at rest and with coughing were 20 (interquartile range 10 to 35) and 50 (interquartile range 29 to 67) respectively at 24 hours. The posterior approach appears to be more appropriate for lower abdominal surgery and the subcostal approach better suited to upper abdominal surgery. Whichever approach is used, transversus abdominis plane block is only one component of a multimodal analgesic technique.
腹横肌平面阻滞通过靶向腹内斜肌和腹横肌之间的胸腰神经为腹部手术后提供术后镇痛。已经描述了使用超声引导的后路和肋下途径。然而，关于感觉阻滞的范围，结果并不一致。这项观察性研究评估了后路或肋下途径后感觉阻滞的分布以及所实现的镇痛质量。经伦理委员会批准后，招募了50例接受微创和大型腹部手术的患者。术前在实时超声引导下共进行了81次腹横肌平面阻滞。术后，患者通过患者自控泵接受包括吗啡在内的多模式镇痛。98%的患者有一定程度的可证实的感觉阻滞，后路和肋下途径的皮节扩散不同（P<0.001）。后路产生的感觉阻滞中位数为三个皮节（四分位间距2至4），最靠头侧的是T10（四分位间距T9至T），而肋下途径阻滞的中位数为四个节段（四分位间距3至5），最靠头侧的是T8（四分位间距T7至T9，P<0.001）。在30分钟时观察到最大皮节阻滞分布，通常在24小时时消退。24小时时吗啡累积消耗量中位数为40.8毫克（四分位间距17至50毫克）。24小时时静息和咳嗽时的疼痛评分中位数分别为20（四分位间距10至35）和50（四分位间距29至67）。后路似乎更适合下腹部手术，肋下途径更适合上腹部手术。无论使用哪种途径，腹横肌平面阻滞只是多模式镇痛技术的一个组成部分。
