Pratheeba N, Remadevi R, Raajesh I Joseph, Bhavani V, Tripathy D K, Bhat R Ravindra
Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Anesth Essays Res. 2018 Jan-Mar;12(1):80-84. doi: 10.4103/aer.AER_201_17.
Optimization and providing excellent quality of postoperative analgesia after total abdominal hysterectomy is a determinant factor of better clinical outcome, increases patient satisfaction, and allows early mobilization of the patient.
The aim of this study is to compare the postoperative analgesic efficacy of wound site infiltration (WSI) and ultrasound-guided transversus abdominis plane block (TAPB) with 0.5% ropivacaine in lower abdominal surgeries under spinal anesthesia.
This was a randomized controlled study.
One hundred and ten patients undergoing lower abdominal surgeries were randomly allocated to two groups (WSI and TAP) of 55 patients in each. At the end of the surgical procedure, 2.5 mg/kg of the drug ropivacaine 0.5% was administered by an anesthesiologist through either of the routes of study. Visual analog score (VAS) assessment was done at every 30 min, for 1½ h, every 2 for 24 h postoperatively. Injection diclofenac sodium 75 mg intramuscularly was given whenever VAS was >3 as rescue analgesic.
Epi Info 7.0 version software for Windows was used. All analyses were performed using Kolmogorov-Smirnov test. Mann-Whitney test was applied to detect the difference between the two groups. < 0.05 was considered statistically significant.
Postoperative VAS scores in Group TAP were significantly reduced at 30 min, 1 h, 1 h 30 min, 2, 4, 6, 8, 10, 12, 18, and 24 h ( < 0.001). The total doses of rescue analgesics administered were also low in the Group TAP (1.41 ± 0.538) with < 0.0001 in comparison to Group WSI (2.24 ± 0.637) with < 0.001.
The quality of analgesia along with lesser rescue analgesic requirement and their side effects makes the TAPB, a good and safer option for lower abdominal gynecological surgeries. Both WSI and USG TAPB are effective in providing postoperative analgesia as a part of multimodal analgesia in lower abdominal surgeries. However, in our study the quality of analgesia along with lesser rescue analgesic requirement and their side effects makes the TAPB, a good and safer option for lower abdominal gynecological surgeries.
优化并提供全腹子宫切除术后的优质镇痛是改善临床结局的决定性因素，可提高患者满意度，并有助于患者早期活动。
本研究旨在比较在脊髓麻醉下的下腹部手术中，伤口局部浸润（WSI）和超声引导腹横肌平面阻滞（TAPB）使用0.5%罗哌卡因的术后镇痛效果。
这是一项随机对照研究。
110例接受下腹部手术的患者被随机分为两组（WSI组和TAP组），每组55例。手术结束时，麻醉医生通过两种研究途径之一给予2.5mg/kg的0.5%罗哌卡因。术后每30分钟进行1.5小时的视觉模拟评分（VAS）评估，术后24小时每2小时评估一次。当VAS评分>3时，肌内注射75mg双氯芬酸钠作为补救镇痛。
使用适用于Windows的Epi Info 7.0版本软件。所有分析均采用Kolmogorov-Smirnov检验。应用Mann-Whitney检验检测两组之间的差异。P<0.05被认为具有统计学意义。
TAP组术后30分钟、1小时、1小时30分钟、2小时、4小时、6小时、8小时、10小时、12小时、18小时和24小时的VAS评分显著降低（P<0.001）。TAP组给予的补救镇痛药总剂量也较低（1.41±0.538），与WSI组（2.24±0.637）相比，P<0.0001，P<0.001。
镇痛质量以及较低的补救镇痛需求及其副作用使TAPB成为下腹部妇科手术的一种良好且更安全的选择。WSI和超声引导TAPB作为下腹部手术多模式镇痛的一部分，在提供术后镇痛方面均有效。然而，在我们的研究中，镇痛质量以及较低的补救镇痛需求及其副作用使TAPB成为下腹部妇科手术的一种良好且更安全的选择。
