Breazu Caius Mihai, Ciobanu Lidia, Hadade Adina, Bartos Adrian, Mitre Călin, Mircea Petru Adrian, Ionescu Daniela
University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.
Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania.
Rom J Anaesth Intensive Care. 2016 Apr;23(1):12-18. doi: 10.21454/rjaic.7518.231.obq.
Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block.
Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement.
The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p < 0.001). The mean 24 h opioid consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p < 0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p < 0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected.
OSTAP block with bupivacaine 0.25% can provide effective analgesia up to 24 hours after laparoscopic cholecystectomy when combined with conventional multimodal analgesia regimen.
考虑到标准镇痛方法的副作用，腹腔镜胆囊切除术后的疼痛控制可能是一项挑战。最近，腹横肌平面阻滞（TAP阻滞）已被用作多模式镇痛的一部分，取得了令人满意的效果。肋下途径（OSTAP阻滞）是TAP阻滞的一种变体，可产生可靠的单侧脐上镇痛效果。本研究评估了布比卡因OSTAP阻滞与安慰剂OSTAP阻滞相比在腹腔镜胆囊切除术中的疗效。
60例拟行择期腹腔镜胆囊切除术的ASA I/II级成年患者被随机分为两组：A组（OSTAP安慰剂组）术前接受双侧无菌生理盐水OSTAP阻滞，B组（OSTAP布比卡因组）术前接受相同体积的0.25%布比卡因双侧OSTAP阻滞。评估术后24小时的阿片类药物消耗量、手术期间所需的阿片类药物剂量、恢复室（PACU）的阿片类药物剂量以及PACU停留时间。在术后24小时内的特定间隔时间，通过视觉模拟量表（VAS）评估静息和活动时的镇痛质量。
两组患者术中阿片类药物平均消耗量存在显著差异（A组为385±72.52毫克，B组为173.67±48.60毫克，p<0.001）。两组患者术后24小时阿片类药物平均消耗量也存在统计学显著差异（32±26.05毫克对79±16.68毫克，p<0.001）。B组患者的PACU停留时间显著低于A组患者（20.67±11.27分钟对41.67±12.41分钟，p<0.001）。在静息和活动状态下，OSTAP布比卡因组在术后0、2、4、6、12、24小时的疼痛评分均显著低于OSTAP安慰剂组。未检测到局部麻醉药全身毒性或其他并发症的体征或症状。
0.25%布比卡因的OSTAP阻滞与传统多模式镇痛方案联合使用时，可在腹腔镜胆囊切除术后长达24小时内提供有效的镇痛效果。
