单侧腹横肌平面阻滞是输尿管冲击波碎石术的一种镇痛替代方法吗？

Is unilateral transversus abdominis plane block an analgesic alternative for ureteric shock wave lithotripsy?

作者信息

Elnabtity Ali Mohamed Ali, Tawfeek Mohamed M, Keera Amr Ali, Badran Yasser Ali

机构信息

Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Department of Anesthesia and Intensive Care, Faculty of Medicine, Benha University, Benha, Egypt.

出版信息

Anesth Essays Res. 2015 Jan-Apr;9(1):51-6. doi: 10.4103/0259-1162.150177.

DOI:10.4103/0259-1162.150177

PMID:25886421

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4383112/

Abstract

BACKGROUND

Various sedative and analgesic techniques have been used during shock wave lithotripsy (SWL).

AIM

This study aimed at evaluating the efficacy of ultrasound-guided unilateral transversus abdominis plane (TAP) block as an analgesic technique alternative during ureteric SWL.

SETTINGS AND DESIGN

Prospective randomized comparative study.

MATERIALS AND METHODS

Fifty patients scheduled for ureteric SWL were randomly allocated into two equal groups: Group (F) received 1.5 mcg/kg fentanyl intravenous and group (T) received unilateral TAP block with injection of 25 ml of bupivacaine 0.25% (62.5 mg).

STATISTICAL ANALYSIS

Statistical analysis was performed using SPSS program version 19 and EP16 program.

RESULTS

The visual analog scale was significantly less in group (T) than in group (F) both intra-operatively (at 10, 20, 30, and 40 min) and postoperatively (at 10 min intervals in the postanesthesia care unit [PACU]) (P < 0.001). Rescue analgesia with pethidine during the procedure and in the PACU was less (P < 0.001) in the group (T) than group (F) with a median of 20 mg versus 55 mg, respectively. The higher sedation scores observed in group (F) at 15, 25, and 35 min during the procedure, and at 20 min during the PACU time were statistically highly significant (P < 0.001), but only significant at 10 min (P = 0.03) and 30 min (P = 0.007) during the PACU time. There was also highly significant decrease (P < 0.001) in the time of PACU stay in group (T) (38.2 ± 6.6 min) compared with group (F) (89.2 ± 13.39 min). We recorded 6 patients in group (F) (24%) who have developed respiratory depression (respiratory rate < 10 breaths/min) compared to 0% in group (T) (P = 0.022). In addition, in group (F) nausea was noted in 8 patients (32%) and vomiting in 6 patients (24%), which was statistically significant when compared to group (T) (0%) (P = 0.01 and 0.022, respectively).

CONCLUSION

Ultrasound-guided unilateral TAP block is an effective alternative analgesic technique during ureteric SWL.

摘要

背景

在冲击波碎石术（SWL）期间已采用多种镇静和镇痛技术。

目的

本研究旨在评估超声引导下的单侧腹横肌平面（TAP）阻滞作为输尿管SWL期间镇痛技术替代方法的疗效。

设置与设计

前瞻性随机对照研究。

材料与方法

50例计划行输尿管SWL的患者被随机分为两组，每组25例：F组静脉注射1.5 mcg/kg芬太尼，T组接受单侧TAP阻滞并注射25 ml 0.25%布比卡因（62.5 mg）。

统计分析

使用SPSS 19版和EP16程序进行统计分析。

结果

在术中（10、20、30和40分钟）及术后（在麻醉后护理单元[PACU]每隔10分钟），T组的视觉模拟评分均显著低于F组（P < 0.001）。术中及PACU期间T组使用哌替啶进行补救镇痛的情况少于F组（P < 0.001），中位数分别为20 mg和55 mg。术中15、25和35分钟以及PACU期间20分钟时F组观察到的较高镇静评分具有高度统计学意义（P < 0.001），但在PACU期间仅在10分钟（P = 0.03）和30分钟（P = 0.007）时具有统计学意义。与F组（89.2 ± 13.39分钟）相比，T组的PACU停留时间也显著缩短（P < 0.001）（38.2 ± 6.6分钟）。我们记录到F组有6例患者（24%）出现呼吸抑制（呼吸频率<10次/分钟），而T组为0%（P = 0.022）。此外，F组有8例患者（32%）出现恶心，6例患者（24%）出现呕吐，与T组（0%）相比具有统计学意义（分别为P = 0.01和P = 0.022）。