Kim Mun Gyu, Kim Soon Im, Ok Si Young, Kim Sang Ho, Lee Se-Jin, Park Sun Young, Yoo Jae-Hwa, Cho Ana, Hur Kyung Yul, Kim Myung Jin
Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Korean J Anesthesiol. 2014 Dec;67(6):398-403. doi: 10.4097/kjae.2014.67.6.398. Epub 2014 Dec 29.
Transverse abdominis plane (TAP) block can be recommended as a multimodal method to reduce postoperative pain in laparoscopic abdominal surgery. However, it is unclear whether TAP block following local anesthetic infiltration is effective. We planned this study to evaluate the effectiveness of the latter technique in laparoscopic totally extraperitoneal hernia repair (TEP).
We randomly divided patients into two groups: the control group (n = 37) and TAP group (n = 37). Following the induction of general anesthesia, as a preemptive method, all of the patients were subjected to local anesthetic infiltration at the trocar sites, and the TAP group was subjected to ultrasound-guided bilateral TAP block with 30 ml of 0.375% ropivacaine in addition before TEP. Pain was assessed in the recovery room and post-surgery at 4, 8, and 24 h. Additionally, during the postoperative 24 h, the total injected dose of analgesics and incidence of nausea were recorded.
On arrival in the recovery room, the pain score of the TAP group (4.33 ± 1.83) was found to be significantly lower than that of the control group (5.73 ± 2.04). However, the pain score was not significantly different between the TAP group and control group at 4, 8, and 24 h post-surgery. The total amounts of analgesics used in the TAP group were significantly less than in the control group. No significant difference was found in the incidence of nausea between the two groups.
TAP block following local infiltration had a clinical advantage only in the recovery room.
腹横肌平面（TAP）阻滞可作为一种多模式方法用于减轻腹腔镜腹部手术的术后疼痛。然而，局部麻醉药浸润后进行TAP阻滞是否有效尚不清楚。我们开展本研究以评估后一种技术在腹腔镜完全腹膜外疝修补术（TEP）中的有效性。
我们将患者随机分为两组：对照组（n = 37）和TAP组（n = 37）。全身麻醉诱导后，作为一种超前镇痛方法，所有患者均在套管针穿刺部位进行局部麻醉药浸润，并且TAP组在TEP术前还接受了超声引导下双侧TAP阻滞，注射30 ml 0.375%的罗哌卡因。在恢复室以及术后4、8和24小时评估疼痛情况。此外，在术后24小时内，记录镇痛药的总注射剂量和恶心的发生率。
到达恢复室时，发现TAP组的疼痛评分（4.33±1.83）显著低于对照组（5.73±2.04）。然而，术后4、8和24小时，TAP组与对照组之间的疼痛评分无显著差异。TAP组使用的镇痛药总量显著少于对照组。两组之间恶心的发生率未发现显著差异。
局部浸润后进行TAP阻滞仅在恢复室具有临床优势。
