Parikh Beena K, Waghmare Vishal T, Shah Veena R, Mehta Tanu, Butala Beena P, Parikh Geeta P, Vora Kalpana S
Department of Anaesthesia and Critical Care, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, Ahmedabad, Gujarat, India.
Saudi J Anaesth. 2013 Jan;7(1):43-7. doi: 10.4103/1658-354X.109808.
Transversus abdominis plane (TAP) block is suitable for lower abdominal surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound (USG)-guided TAP block for retroperitoneoscopic donor nephrectomy (RDN).
In a prospective randomized double-blind study, 60 patients undergoing laparoscopic donor nephrectomy were randomly divided into two groups by closed envelope method. At the end of surgery, USG-guided TAP block was given to the patients of both the groups. Study group (group S) received inj. Bupivacaine (0.375%), whereas control group (group C) received normal saline. Inj. Tramadol (1 mg/kg) was given as rescue analgesic at visual analog scale (VAS) more than 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS both at rest and on movement, time tofirst dose of rescue analgesic, cumulative dose of tramadol, sedation score, and nausea score, which were also noted at 30 min, 2, 4, 6, 12, 18, and 24 h postoperatively. Total tramadol consumption at 24 h was also assessed.
Patients in group S had significantly lower VAS score, longer time tofirst dose of rescue analgesic (547.13±266.96 min vs. 49.17±24.95 min) and lower tramadol consumption (103.8±32.18 mg vs. 235.8±47.5 mg) in 24 h.
The USG-guided TAP block is easy to perform and effective as a postoperative analgesic regimen in RDN, with opioids-sparing effect and without any complications.
腹横肌平面（TAP）阻滞适用于下腹部手术。盲法TAP阻滞有许多并发症且效果存在不确定性。超声检查的应用提高了安全性和有效性。本研究旨在评估超声（USG）引导下TAP阻滞用于后腹腔镜供肾切除术（RDN）的镇痛效果。
在一项前瞻性随机双盲研究中，60例行腹腔镜供肾切除术的患者通过封闭信封法随机分为两组。手术结束时，两组患者均接受USG引导下的TAP阻滞。研究组（S组）给予布比卡因注射液（0.375%），而对照组（C组）给予生理盐水。在任何一组患者静息或活动时视觉模拟评分（VAS）大于3时，给予曲马多注射液（1mg/kg）作为补救性镇痛药。通过静息和活动时的VAS、首次使用补救性镇痛药的时间、曲马多的累积剂量、镇静评分和恶心评分来判断镇痛效果，这些指标也在术后30分钟、2、4、6、12、18和24小时记录。还评估了24小时内曲马多的总消耗量。
S组患者的VAS评分显著更低，首次使用补救性镇痛药的时间更长（547.13±266.96分钟对49.17±24.95分钟），24小时内曲马多消耗量更低（103.8±32.18毫克对235.8±47.5毫克）。
USG引导下的TAP阻滞操作简便，作为RDN术后镇痛方案有效，具有节省阿片类药物的作用且无任何并发症。
