Li Kai, Li Longyun, Gao Ming, Zhu Zhihua, Chen Peng, Yang Li, Zhao Guoqing
Department of Anesthesia, China-Japan Union Hospital of Jilin University Changchun 130021, China.
Int J Clin Exp Med. 2015 Aug 15;8(8):13976-82. eCollection 2015.
To observe intraoperative and postoperative analgesic effect of ultrasound-guided subcostal transversus abdominis plane (TAP) block in gastric cancer patients undergoing open gastrectomy.
Forty patients with gastric cancer underwent open gastrectomy were randomly assigned into groups R and S. All patients received ultrasound-guided subcostal bilateral TAP under general anesthesia, and then were injected with 40 ml of 0.375% ropivacaine (group R) or equivalent amount of normal saline (group S). The surgery was performed in 30 min following the blocking. Intraoperatively, BIS value was maintained between 45 and 65. Patient-controlled intravenous analgesia pump was properly connected after the operation. Intraoperative changes in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were observed and the dosage of sufentanil and alternative drugs was closely monitored during the surgery. Visual analogue scale (VAS) scores and related surgical complications were recorded at 2, 4, 6, 12, 24 and 48 h following the operation.
The SBP, DBP and HR changes in the group R were significantly decreased compared with those in the group S (all P<0.01). In both groups, desirable analgesic effect was obtained. The VAS scores at postoperative 2, 4, 6 and 12 h after the surgery in the group R were significantly lower than those in the group S (all P<0.05). No TAP puncture-induced adverse reaction was observed in both groups.
Ultrasound-guided subcostal transversus abdominis plane block has the advantages of accurate localization and high success rate. Clinical application of this technique in open gastrectomy can significantly decrease intraoperative and postoperative dosage of analgesics and exert desirable analgesic effect.
观察超声引导下肋下腹横肌平面（TAP）阻滞在胃癌根治术患者中的术中和术后镇痛效果。
将40例行胃癌根治术的患者随机分为R组和S组。所有患者均在全身麻醉下接受超声引导下双侧肋下TAP阻滞，然后R组注射40 ml 0.375%罗哌卡因，S组注射等量生理盐水。阻滞完成后30分钟进行手术。术中，脑电双频指数（BIS）值维持在45至65之间。术后妥善连接患者自控静脉镇痛泵。观察术中收缩压（SBP）、舒张压（DBP）和心率（HR）的变化，并在手术过程中密切监测舒芬太尼及替代药物的用量。记录术后2、4、6、12、24和48小时的视觉模拟评分（VAS）及相关手术并发症。
与S组相比，R组的SBP、DBP和HR变化显著降低（均P<0.01）。两组均获得了理想的镇痛效果。R组术后2、4、6和12小时的VAS评分显著低于S组（均P<0.05）。两组均未观察到TAP穿刺引起的不良反应。
超声引导下肋下腹横肌平面阻滞具有定位准确、成功率高的优点。该技术在胃癌根治术中的临床应用可显著减少术中和术后镇痛药用量，并发挥理想的镇痛效果。
