Abdelsalam Khaled, Mohamdin O W
Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Anesthesia, Faculty of Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia.
Department of Anesthesia, Faculty of Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia.
Saudi J Anaesth. 2016 Jan-Mar;10(1):25-8. doi: 10.4103/1658-354X.169470.
Regional anesthetic techniques can be used to alleviate postoperative pain in patients undergoing major upper abdominal surgery. Our aim was to evaluate the efficacy of bilateral ultrasound (US)-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks for better perioperative analgesia.
It is a prospective, observer-blinded, randomized clinical study. 40 eligible patients undergoing elective liver resection or Whipple procedure were included. All patients received a standardized anesthetic technique. Group 1 (n = 20) received preincisional US-guided bilateral RS and TAP blocks using 20 ml volume of bupivacaine 0.25% for each, and group 2 (n = 20) received local wound infiltration at end of surgery with 40 ml of bupivacaine 0.25%. A standardized postoperative analgesic regimen composed of intravenous paracetamol and a morphine patient-controlled analgesia (PCA). The use of intraoperative fentanyl and recovery room morphine boluses, PCA-administered morphine, pain scores as well as number of patients' experienced postoperative nausea and vomiting in the ward at 6 and 24 h were recorded.
Group 1 patients received a significantly lower cumulative intraoperative fentanyl, significantly lesser boluses of morphine in postanesthesia care unit, as well, significantly lower cumulative 24 h postoperative morphine dosage than the group 2 patients. Pain visual analog scale scores were significantly lower at both 6 and 24 h postoperatively in TAP group when compared with the no-TAP group. There were no complications related to the TAP block procedures. No signs or symptoms of local anesthetic systemic toxicity were detected.
The combination of bilateral US-guided RS and TAP blocks provides excellent perioperative analgesia for major upper abdominal surgery.
区域麻醉技术可用于缓解接受上腹部大手术患者的术后疼痛。我们的目的是评估双侧超声引导下腹直肌鞘（RS）阻滞和腹横肌平面（TAP）阻滞在改善围手术期镇痛方面的效果。
这是一项前瞻性、观察者盲法、随机对照临床研究。纳入40例接受择期肝切除术或惠普尔手术的符合条件患者。所有患者均接受标准化麻醉技术。第1组（n = 20）在切开前接受双侧超声引导下RS和TAP阻滞，每侧使用20 ml 0.25%布比卡因，第2组（n = 20）在手术结束时接受40 ml 0.25%布比卡因局部伤口浸润。采用由静脉注射对乙酰氨基酚和吗啡患者自控镇痛（PCA）组成的标准化术后镇痛方案。记录术中芬太尼的使用情况、恢复室吗啡推注量、PCA使用的吗啡量、疼痛评分以及患者在病房6小时和24小时时术后恶心呕吐的发生例数。
与第2组患者相比，第1组患者术中芬太尼累积用量显著更低，麻醉后护理单元吗啡推注量显著更少，术后24小时吗啡累积用量也显著更低。与非TAP组相比，TAP组术后6小时和24小时的疼痛视觉模拟量表评分均显著更低。未发生与TAP阻滞操作相关的并发症。未检测到局部麻醉药全身毒性的体征或症状。
双侧超声引导下RS和TAP阻滞联合应用可为上腹部大手术提供出色的围手术期镇痛效果。
