四象限腹横肌平面(TAP)阻滞与连续后路 TAP 镇痛与硬膜外镇痛在腹腔镜结直肠手术患者中的镇痛效果比较:一项开放标签、随机、非劣效性试验。
Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial.
机构信息
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.
出版信息
Anaesthesia. 2014 Apr;69(4):348-55. doi: 10.1111/anae.12546.
Posterior transversus abdominis plane blocks have been reported to be an effective method of providing analgesia after lower abdominal surgery. We compared the efficacy of a novel technique of providing continuous transversus abdominis plane analgesia with epidural analgesia in patients on an enhanced recovery programme following laparoscopic colorectal surgery. A non-inferiority comparison was used. Adult patients undergoing elective laparoscopic colorectal surgery were randomly assigned to receive continuous transversus abdominis plane analgesia (n = 35) vs epidural analgesia (n = 35), in addition to a postoperative analgesic regimen comprising regular paracetamol, regular diclofenac and tramadol as required. Sixty-one patients completed the study. The transversus group received four-quadrant transversus abdominis plane blocks and bilateral posterior transversus abdominis plane catheters that were infused with levobupivacaine 0.25% for 48 h. The epidural group received an infusion of bupivacaine and fentanyl. The primary outcome measure was visual analogue scale pain score on coughing at 24 h after surgery. We found no significant difference in median (IQR [range]) visual analogue scores during coughing at 24 h between the transversus group 2.5 (1.0-3.0 [0-5.5]) and the epidural group 2.5 (1.0-5.0 [0-6.0]). The one-sided 97.5% CI was a 0.0 (∞-1.0) difference in means, establishing non-inferiority. There were no significant differences between the groups for tramadol consumption. Success rate was 28/30 (93%) in the transversus group vs 27/31 (87%) in the epidural group. Continuous transversus abdominis plane infusion was non-inferior to epidural infusion in providing analgesia after laparoscopic colorectal surgery.
经横腹部平面阻滞已被报道为一种有效的下腹部手术后镇痛方法。我们比较了一种新的连续横腹部平面镇痛技术与硬膜外镇痛在腹腔镜结直肠手术后强化康复方案患者中的效果。采用非劣效性比较。择期行腹腔镜结直肠手术的成年患者被随机分为连续横腹部平面镇痛组(n = 35)和硬膜外镇痛组(n = 35),此外还接受包括常规扑热息痛、常规双氯芬酸和曲马多按需使用的术后镇痛方案。61 例患者完成了研究。横腹部组接受了四象限横腹部平面阻滞和双侧后横腹部平面导管,输注左旋布比卡因 0.25%,持续 48 小时。硬膜外组接受布比卡因和芬太尼输注。主要结局测量指标为术后 24 小时咳嗽时的视觉模拟评分(VAS)疼痛评分。我们发现,在 24 小时咳嗽时,横腹部组的中位数(IQR [范围])VAS 评分 2.5(1.0-3.0 [0-5.5])与硬膜外组的中位数(IQR [范围])2.5(1.0-5.0 [0-6.0])之间无显著差异。单侧 97.5%置信区间为均值差异 0.0(∞-1.0),表明非劣效性。两组间曲马多消耗量无显著差异。横腹部组的成功率为 28/30(93%),硬膜外组为 27/31(87%)。连续横腹部平面输注在腹腔镜结直肠手术后提供镇痛方面不劣于硬膜外输注。