Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2013 Apr;57(4):502-8. doi: 10.1111/aas.12080. Epub 2013 Feb 7.
Open radical retropubic prostatectomy (ORRP) is associated with moderate pain. We hypothesized that a transversus abdominis plane (TAP) block would reduce post-operative pain, morphine consumption and opioid-related side effects compared with wound infiltration and placebo in this population.
This was a randomized, double-blind and placebo-controlled study. The operations were performed with patients in general anaesthesia. Patients were allocated to receive either bilateral TAP block (n = 23), wound infiltration (n = 25) or placebo (n = 25). Treatment was 40 ml ropivacaine 0.75% and placebo was 40 ml saline 0.9%. Pre-operatively, all patients received oral gabapentin, ibuprofen and paracetamol, followed by oral paracetamol and ibuprofen at regular doses and intervals, and patient-controlled analgesia with IV morphine from 0 h to 24 h post-operatively.
Visual analogue scale pain score during mobilization 4 h post-operatively (primary outcome) did not differ significantly between the TAP block and placebo group (TAP 28 ± 22 mm vs. placebo 33 ± 18 mm, P = 0.64). Pain scores (as area under the curve) during the first 24 h were not significantly different among any of the three groups, neither at rest nor during mobilization. Morphine consumption (0-24 h) did not differ significantly between groups {TAP block = 15 [8-23] mg, infiltration 15 [8-36] mg, placebo 15 [3-30] mg, [median (interquartile range)]}. Levels of nausea, sedation and number of vomits were not different among the groups.
Neither TAP block nor wound infiltration with ropivacaine improved a basic multimodal analgesic regimen with paracetamol, ibuprofen and gabapentin after ORRP.
开放式经耻骨后前列腺切除术（ORRP）伴有中度疼痛。我们假设与伤口浸润和安慰剂相比，腹横肌平面（TAP）阻滞在该人群中可减少术后疼痛、吗啡消耗和阿片类药物相关的副作用。
这是一项随机、双盲和安慰剂对照研究。手术在全身麻醉下进行。患者被分配接受双侧 TAP 阻滞（n = 23）、伤口浸润（n = 25）或安慰剂（n = 25）。治疗为 40 ml 0.75%罗哌卡因，安慰剂为 40 ml 0.9%生理盐水。所有患者术前均接受口服加巴喷丁、布洛芬和对乙酰氨基酚，术后给予口服对乙酰氨基酚和布洛芬，并按常规剂量和间隔给予口服，术后 0 至 24 小时给予静脉注射吗啡自控镇痛。
术后 4 小时（主要结局）活动时的视觉模拟评分（VAS）在 TAP 阻滞组和安慰剂组之间无显著差异（TAP 28 ± 22 mm 与安慰剂 33 ± 18 mm，P = 0.64）。三组中，无论在休息时还是在活动时，24 小时内的疼痛评分（作为曲线下面积）均无显著差异。吗啡消耗量（0-24 小时）在各组之间也无显著差异（TAP 阻滞组 15 [8-23] mg，浸润组 15 [8-36] mg，安慰剂组 15 [3-30] mg，[中位数（四分位间距）]）。各组之间恶心、镇静程度和呕吐次数无差异。
与术后接受对乙酰氨基酚、布洛芬和加巴喷丁的基本多模式镇痛方案相比，TAP 阻滞或罗哌卡因伤口浸润均未改善 ORRP 后的镇痛效果。
