腹腔镜腹横肌平面阻滞技术在择期腹腔镜胆囊切除术中的疗效：一项前瞻性、双盲随机试验。
Efficacy of a Laparoscopically Delivered Transversus Abdominis Plane Block Technique during Elective Laparoscopic Cholecystectomy: A Prospective, Double-Blind Randomized Trial.
机构信息
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
出版信息
J Am Coll Surg. 2015 Aug;221(2):335-44. doi: 10.1016/j.jamcollsurg.2015.03.030. Epub 2015 Mar 27.
BACKGROUND
The management of postoperative pain is paramount to facilitate the delivery of day case surgical programs. In recent years, the complexity of procedures carried out has increased to include laparoscopic cholecystectomy. The aim of this study was to evaluate the impact of laparoscopic-assisted 4-quadrant transversus abdominis plane (TAP) block vs periportal local anesthetic wound infiltration in managing postoperative pain.
STUDY DESIGN
A prospective, randomized, double-blinded trial was conducted with patients undergoing elective laparoscopic cholecystectomy. Patients were randomized using computerized "random number table" into a test group that received laparoscopic-assisted TAP block with bupivacaine with periportal saline injection and a control group that received a laparoscopic-assisted TAP block with saline and periportal bupivacaine. All patients received intraperitoneal instillation of bupivacaine in the gallbladder bed. Postoperative pain scores were recorded using numerical rating scores at rest and coughing at dedicated time points. Statistical analysis was carried out using GraphPad Prism software, version 5 (GraphPad Software) and p < 0.05 was considered significant.
RESULTS
Eighty patients (70 female and 10 male) were enrolled; 40 patients were randomized to each group. Age, American Society of Anesthesiologists score, operative time, and BMI were comparable between the groups. No adverse events were encountered with the administration of TAP blocks. Numerical rating scores were significantly reduced in the test group at 1, 3, and 6 hours at rest (p = 0.025, p = 0.03, and p = 0.007, respectively). Numerical rating score was significantly reduced at 1, 3, and 6 hours during coughing (p = 0.026, p = 0.02, and p = 0.03, respectively). Difference in postoperative analgesic requirements between both groups was statistically insignificant (p = 0.17).
CONCLUSIONS
This analysis has confirmed the therapeutic benefit of laparoscopically delivered TAP blocks in elective laparoscopic cholecystectomy.
背景
术后疼痛管理对于促进日间手术计划的实施至关重要。近年来，手术的复杂性增加了，包括腹腔镜胆囊切除术。本研究旨在评估腹腔镜辅助四象限腹横肌平面（TAP）阻滞与门静脉周围局部麻醉浸润在管理术后疼痛方面的影响。
研究设计
这是一项前瞻性、随机、双盲试验，纳入了接受择期腹腔镜胆囊切除术的患者。患者使用计算机化“随机数表”随机分为试验组和对照组。试验组接受腹腔镜辅助 TAP 阻滞，布比卡因加门静脉生理盐水注射；对照组接受腹腔镜辅助 TAP 阻滞，生理盐水加门静脉布比卡因注射。所有患者均在胆囊床行腹腔内布比卡因灌洗。在特定时间点，使用数字评分法记录静息和咳嗽时的术后疼痛评分。使用 GraphPad Prism 软件（GraphPad Software）进行统计学分析，p<0.05 为差异有统计学意义。
结果
共纳入 80 例患者（70 例女性，10 例男性），每组 40 例。两组患者的年龄、美国麻醉医师协会评分、手术时间和 BMI 均无差异。TAP 阻滞的不良反应发生率为零。在静息状态下，试验组在 1、3 和 6 小时时的数字评分显著降低（p=0.025、p=0.03 和 p=0.007）。在咳嗽时，试验组在 1、3 和 6 小时时的数字评分也显著降低（p=0.026、p=0.02 和 p=0.03）。两组患者术后镇痛需求的差异无统计学意义（p=0.17）。
结论
本分析证实了腹腔镜 TAP 阻滞在择期腹腔镜胆囊切除术中的治疗效果。
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