Department of Anesthesiology and Pain Medicine, Amiralmomenin Hospital, Tehran, Islamic Republic of Iran.
Korean J Pain. 2013 Oct;26(4):374-8. doi: 10.3344/kjp.2013.26.4.374. Epub 2013 Oct 2.
Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours.
Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB.
There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P > 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P < 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications.
This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.
子宫切除术后切口疼痛特别麻烦。一种称为腹横肌平面阻滞（TAPB）的方法在管理术后疼痛方面显示出前景。在这项研究中，我们评估了超声引导 TAPB 在子宫切除术后不同时间点和 48 小时内每个时间点的镇痛效果。
选择 42 名（ASA I、II）择期行全子宫切除术的患者，分为 2 组，对照组（C 组）和干预组（I 组）。21 例患者行 TAPB（I 组），21 例患者仅接受芬太尼泵标准治疗（C 组）。两组均接受标准全身麻醉。对于 I 组患者，在手术后和麻醉苏醒前，在内部斜肌和腹横肌之间使用 sonography 双侧注射 0.5mg/kg 的罗哌卡因 0.2%（约 20cc）。在 TAPB 后 2、6、12、24 和 48 小时，使用视觉模拟评分（VAS）和药物消耗测量疼痛评分。
两组患者的人口统计学特征无显著差异。尽管在不同时间点比较 I 组和 C 组的平均 VAS 测量值时没有与时间的相互作用，但 I 组的 VAS 评分似乎较低（P>0.05）。C 组的芬太尼流量始终较高，但当我们分别比较两组在每个时间点时，观察到的差异没有统计学意义（P<0.053）。I 组呕吐发生率为 10%，C 组为 28%。没有瘙痒的投诉，镇静评分在 0 到 3 之间。没有并发症。
本研究表明，TAPB 并未导致不同时间点 VAS 评分的统计学显著降低。TAPB 确实导致芬太尼流量减少，但当我们分别比较两组在每个时间点时，观察到的差异没有统计学意义。
