Park Jun-Seok, Choi Gyu-Seog, Kwak Kyung-Hwa, Jung Hoon, Jeon Younghoon, Park Sungsik, Yeo Jinseok
Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
J Surg Res. 2015 May 1;195(1):61-6. doi: 10.1016/j.jss.2014.12.034. Epub 2014 Dec 23.
Recently, nonopioid-based treatment modalities have been used to improve analgesia and decrease opioid-related side effects after surgery. Transversus abdominis plane (TAP) block and local infiltration of the surgical wound are commonly used multimodal analgesia techniques after abdominal surgery; however, few studies have compared the effectiveness of a TAP block with that of local infiltration of surgical wounds in patients who have undergone laparoscopic colorectal surgery.
Sixty patients undergoing laparoscopic colorectal surgery participated in this prospective comparative study. All patients were allocated to 1 of 2 groups as follows: the TAP group or the infiltration group. Patients in the TAP group received bilateral TAP blocks at the end of the surgery. Patients in the infiltration group received local infiltration of anesthetics in the surgical wounds after closure of the peritoneum. All patients received postoperative analgesia with morphine as a patient-controlled analgesia. Opioid consumption and pain scores were recorded at 2, 6, 24, and 48 h after the operation.
The characteristics of patients in the TAP group (n = 30) and local infiltration group (n = 29) were comparable. Pain scores while coughing and at rest were not different between the two groups. Postoperative morphine use was significantly reduced in the TAP group compared with that in the local infiltration group at 2-6 h (2.9 ± 1.9 mg versus 4.5 ± 3.2 mg, P = 0.02), 6-24 h (5.5 ± 3.3 mg versus 10.2 ± 8.4 mg, P = 0.00), the first 24 h (16.6 ± 6.6 mg versus 24.0 ± 9.7 mg), and 48 h (23.6 ± 8.2 mg versus 31.8 ± 12.5 mg, P = 0.00). No differences in rescue analgesic use or side effects were noted between the groups.
Compared with local anesthetic infiltration, bilateral TAP blocks decreased the cumulative morphine use at 24 h and 48 h postoperatively in patients who had undergone laparoscopic colorectal surgery.
最近，非阿片类治疗方式已被用于改善手术后的镇痛效果并减少阿片类药物相关的副作用。腹横肌平面（TAP）阻滞和手术切口局部浸润是腹部手术后常用的多模式镇痛技术；然而，很少有研究比较TAP阻滞与手术切口局部浸润在接受腹腔镜结直肠手术患者中的有效性。
60例接受腹腔镜结直肠手术的患者参与了这项前瞻性比较研究。所有患者被分配到以下2组中的1组：TAP组或浸润组。TAP组患者在手术结束时接受双侧TAP阻滞。浸润组患者在腹膜关闭后接受手术切口局部麻醉药浸润。所有患者术后均使用吗啡进行患者自控镇痛。记录术后2、6、24和48小时的阿片类药物消耗量和疼痛评分。
TAP组（n = 30）和局部浸润组（n = 29）患者的特征具有可比性。两组咳嗽时和休息时的疼痛评分无差异。与局部浸润组相比，TAP组术后2 - 6小时（2.9±1.9毫克对4.5±3.2毫克，P = 0.02）、6 - 24小时（5.5±3.3毫克对10.2±8.4毫克，P = 0.00）、前24小时（16.6±6.6毫克对24.0±9.7毫克）和48小时（23.6±8.2毫克对31.8±12.5毫克，P = 0.00）的吗啡使用量显著减少。两组间在补救性镇痛药物使用或副作用方面未观察到差异。
与局部麻醉药浸润相比，双侧TAP阻滞可减少接受腹腔镜结直肠手术患者术后24小时和48小时的吗啡累积使用量。
