Departments of Anaesthesia, Prince of Wales and Sydney Children's Hospitals, High St Randwick, NSW 2031, Australia.
Br J Anaesth. 2011 Jun;106(6):882-6. doi: 10.1093/bja/aer069. Epub 2011 Apr 18.
The effect of adding transversus abdominis plane (TAP) blocks to local anaesthetic infiltration on morphine consumption and postoperative pain in children undergoing laparoscopic appendicectomy is unknown.
After random allocation, 93 children aged 7-16 were randomized to receive ultrasound-guided TAP blocks placed before surgery or not (control). All subjects had port sites infiltrated with ropivacaine and were prescribed i.v. patient-controlled analgesia (PCA) with morphine and oral paracetamol for postoperative pain. The primary outcome was the proportion of subjects using >200 µg kg(-1) morphine. Secondary outcomes included PCA morphine use, pain scores, time intervals to the first use of PCA and other analgesics, sedation scores, postoperative nausea or vomiting, and time to hospital discharge.
The procedure duration was longer in the TAP group (111 compared with 97 min for controls, P=0.03). The duration in the recovery ward and that of the hospital stay were similar. There was no difference in the proportion of subjects requiring >200 µg kg(-1) of PCA morphine [control 31/45 (69%), TAP 29/42 (69%), P=0.99]. There was no significant difference in PCA morphine use, time intervals to the first use of PCA or other analgesics, or amounts of other analgesics. More patients in the TAP group had complicated appendicitis [TAP 13/42 (31%), control 5/45 (11%), P=0.02]. Pain scores were reduced for the TAP group in the recovery ward only (median score 0 vs 2, 95% confidence interval 0-3, P=0.03).
TAP blocks increased anaesthesia time by 14 min on average but offered no clinically important benefit over local anaesthetic port-site infiltration to paediatric patients undergoing laparoscopic appendicectomy.
在接受腹腔镜阑尾切除术的儿童中，向局部麻醉浸润中加入腹横肌平面（TAP）阻滞是否会影响吗啡的使用量和术后疼痛尚不清楚。
随机分组后，93 名 7-16 岁的儿童被随机分为接受或不接受超声引导下 TAP 阻滞（对照组）。所有患者均在切口部位注射罗哌卡因，并给予静脉自控镇痛（PCA），包括吗啡和口服扑热息痛以缓解术后疼痛。主要结局是使用>200μg/kg 吗啡的患者比例。次要结局包括 PCA 吗啡用量、疼痛评分、首次使用 PCA 和其他镇痛药物的时间间隔、镇静评分、术后恶心或呕吐以及出院时间。
TAP 组的手术时间较长（111 分钟比对照组的 97 分钟，P=0.03）。但在恢复室和住院期间的时间差异无统计学意义。需要>200μg/kg 吗啡的患者比例在两组之间没有差异[对照组 31/45（69%），TAP 组 29/42（69%），P=0.99]。PCA 吗啡使用量、首次使用 PCA 或其他镇痛药物的时间间隔或其他镇痛药物的用量也没有显著差异。TAP 组有更多的复杂性阑尾炎患者[TAP 组 13/42（31%），对照组 5/45（11%），P=0.02]。TAP 组仅在恢复室时疼痛评分降低（中位数评分 0 分比 2 分，95%置信区间 0-3，P=0.03）。
TAP 阻滞平均增加麻醉时间 14 分钟，但与局部麻醉切口浸润相比，对接受腹腔镜阑尾切除术的儿童没有提供临床重要的益处。
Zotero 插件