Saliminia Alireza, Azimaraghi Omid, Babayipour Shiva, Ardavan Kamelia, Movafegh Ali
Anesthesiology and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Research Development Center, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Acta Anaesthesiol Taiwan. 2015 Dec;53(4):119-22. doi: 10.1016/j.aat.2015.07.003. Epub 2015 Aug 15.
Transversus abdominis plane (TAP) block is a recently introduced regional anesthesia technique that is used for postoperative pain reduction in some abdominal surgeries. The present study evaluated the efficacy of the TAP block on the post laparoscopic cholecystectomy pain intensity and analgesic consumption.
Fifty-four patients were enrolled in three groups: TAP block with normal saline (Group 1, n = 18); TAP block with bupivacaine (Group 2, n = 18); and TAP block with bupivacaine plus sufentanil (Group 3, n = 18). The time to the first fentanyl request, fentanyl consumption in the 24 hours following surgery, and postoperative pain intensity at 30 minutes, 1 hour, 6 hours, 12 hours, and 24 hours following discharge for recovery were measured and recorded.
The total amount of 24-hour fentanyl consumption was higher in Group 1 (877.8 ± 338.8 μg) than either Group 2 (566.7 ± 367.8 μg) or Group 3 (555.5 ± 356.8 μg; p = 0.03). Postoperative pain score was higher in Group 1 than intervention groups (p = 0.006); however, there was no significant difference in intervention groups. The time to the first fentanyl request in Group 1 (79.44 ± 42.2) was significantly lower than Group 3 (206.38 ± 112.7; p = 0.001).
The present study demonstrated that bilateral TAP block with 0.5% bupivacaine reduces post laparoscopic cholecystectomy pain intensity and fentanyl request and prolongs time to the first analgesic request. Adding sufentanil to the block solution reduced neither pain intensity nor fentanyl further consumption.
腹横肌平面(TAP)阻滞是一种最近引入的区域麻醉技术,用于某些腹部手术的术后疼痛减轻。本研究评估了TAP阻滞对腹腔镜胆囊切除术后疼痛强度和镇痛药物消耗量的效果。
54例患者被纳入三组:生理盐水TAP阻滞组(第1组,n = 18);布比卡因TAP阻滞组(第2组,n = 18);布比卡因加舒芬太尼TAP阻滞组(第3组,n = 18)。测量并记录首次要求使用芬太尼的时间、术后24小时内芬太尼的消耗量以及出院恢复后30分钟、1小时、6小时、12小时和24小时的术后疼痛强度。
第1组24小时芬太尼总消耗量(877.8 ± 338.8 μg)高于第2组(566.7 ± 367.8 μg)或第3组(555.5 ± 356.8 μg;p = 0.03)。第1组术后疼痛评分高于干预组(p = 0.006);然而,干预组之间无显著差异。第1组首次要求使用芬太尼的时间(79.44 ± 42.2)显著低于第3组(206.38 ± 112.7;p = 0.001)。
本研究表明,0.5%布比卡因双侧TAP阻滞可降低腹腔镜胆囊切除术后疼痛强度和芬太尼需求量,并延长首次镇痛要求的时间。在阻滞溶液中添加舒芬太尼既未进一步降低疼痛强度,也未减少芬太尼消耗量。