Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland.
Anesth Analg. 2012 Oct;115(4):953-7. doi: 10.1213/ANE.0b013e3182642117. Epub 2012 Jul 4.
The transversus abdominis plane (TAP) block has proven effective in reducing opioid requirements and pain scores for some procedures involving the lower abdominal wall. In this study we assessed its efficacy in patients with end-stage renal failure undergoing cadaveric renal transplantation.
Sixty-five adult renal transplant recipients were prospectively randomized to receive a standard general anesthetic technique supplemented with levobupivacaine 0.375% 20 mL TAP block or sham block with 20 mL 0.9% saline. Both groups received patient-controlled morphine analgesia and acetaminophen. Patient assessment occurred in the postanesthetic care unit and at 2, 4, 6, 12, and 24 hours. The primary outcome was total morphine consumption in the first 24 hours after renal transplantation. Other outcomes assessed included pain scores, presence of nausea or vomiting, excessive sedation, and respiratory depression.
Morphine requirements did not differ between the 2 groups, 31.6 ± 5.6 mg in the TAP group and 32.6 ± 5.5 mg in the control group (95% confidence interval [CI], -8.96 to 7.09, P = 0.817). Pain scores also did not differ significantly at any time point after surgery. Nausea was reported in 53% of the TAP group and 24% of the control group. The relative risk of nausea associated with treatment was 2.2 (95% CI, 1.1 to 4.3, P = 0.017). No patient exhibited excessive sedation or respiratory depression.
The addition of a TAP block to the analgesia regimen for renal transplantation did not reduce morphine requirements.
腹横肌平面（TAP）阻滞已被证明可有效减少某些涉及下腹部壁的手术的阿片类药物需求和疼痛评分。在这项研究中，我们评估了其在接受尸体肾移植的终末期肾衰竭患者中的功效。
65 名成年肾移植受者前瞻性随机分为接受标准全身麻醉技术加左旋布比卡因 0.375%20 mL TAP 阻滞或假阻滞加 20 mL 0.9%盐水的组。两组均接受患者自控吗啡镇痛和对乙酰氨基酚。患者评估发生在麻醉后护理单位和 2、4、6、12 和 24 小时。主要结局是肾移植后 24 小时内的总吗啡消耗量。评估的其他结果包括疼痛评分、恶心或呕吐的存在、过度镇静和呼吸抑制。
TAP 组和对照组的吗啡需求无差异，分别为 31.6±5.6mg 和 32.6±5.5mg（95%置信区间[CI]，-8.96 至 7.09，P=0.817）。手术后任何时间点的疼痛评分也无显著差异。TAP 组有 53%的患者报告恶心，对照组有 24%的患者报告恶心。与治疗相关的恶心的相对风险为 2.2（95%CI，1.1 至 4.3，P=0.017）。没有患者出现过度镇静或呼吸抑制。
在肾移植的镇痛方案中添加 TAP 阻滞并不能减少吗啡的需求。
