Aboelela Mohamed Adel, Kandeel Al-Refaey, Elsayed Usama, Elmorshedi Mohamed, Elsarraf Waleed, Elsayed Eman, Elgawalby Ahmed, Sultan Ahmed Mohamed, Wahab Mohamed Abdel, Yassen Amr
Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt.
Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt.
Saudi J Anaesth. 2018 Apr-Jun;12(2):297-303. doi: 10.4103/sja.SJA_577_17.
Transversus abdominis plane (TAP) block is a promising technique for analgesia after abdominal surgery. This prospective, randomized controlled trial assessed the effect of adding dexmedetomidine to bupivacaine in TAP block for donor hepatectomy. We hypothesized that this would improve postoperative morphine consumption and reduce analgesia related complication and inflammation.
A total of 50 donor hepatectomy were enrolled in this study. Patients divided into two equal groups according to drugs used for TAP block. Group (B) received 20 ml of bupivacaine hydrochloride 0.25%, Group (BD) received 20 ml of bupivacaine hydrochloride 0.25% and 0.3 μg/kg dexmedetomidine, on both sides at the end of surgery and every 8 h for 48 h at right side only through inserted catheter. Primary outcome objective was morphine consumption at first 72 h. Secondary outcome objectives were morphine requirement, numbers of intake, time to first intake, pain score numerical analog scale (NAS), postoperative analgesia related complications, recovery of intestinal motility, and inflammatory markers.
Data were analyzed, rescue morphine analgesia was significantly lower in (BD) group compared with (B) groups as considering total morphine consumption (B 4 ± 1.9, BD 1.5 ± 0.5, = 0.03), numbers of morphine intake ( = 0.04), morphine requirement ( = 0.03), and first time of analgesia intake ( = 0.04). NAS was significantly lower in group (BD) compared with group (B) group in the first 12 h (NAS 0 - = 0.001, NAS 1 - = 0.03). Adding dexmedetomidine improved gut motility, first oral intake without detectable anti-inflammatory effect.
Adding dexmedetomidine to bupivacine in a surgically inserted catheter for TAP block in donor hepatectomy reduced morphine consumption without detectable anti-inflammatory effect.
腹横肌平面（TAP）阻滞是一种用于腹部手术后镇痛的有前景的技术。这项前瞻性随机对照试验评估了在供体肝切除术中TAP阻滞时将右美托咪定添加到布比卡因中的效果。我们假设这将改善术后吗啡消耗量并减少镇痛相关并发症和炎症。
本研究共纳入50例供体肝切除术患者。根据用于TAP阻滞的药物将患者分为两组。（B）组接受20毫升0.25%盐酸布比卡因，（BD）组接受20毫升0.25%盐酸布比卡因和0.3μg/kg右美托咪定，在手术结束时双侧给药，术后仅在右侧通过插入的导管每8小时给药一次，共48小时。主要结局指标是最初72小时的吗啡消耗量。次要结局指标是吗啡需求量、给药次数、首次给药时间、疼痛评分数字模拟量表（NAS）、术后镇痛相关并发症、肠蠕动恢复情况以及炎症标志物。
对数据进行分析，从总吗啡消耗量（B组4±1.9，BD组1.5±0.5，P = 0.03）、吗啡给药次数（P = 0.04）、吗啡需求量（P = 0.03）和首次镇痛给药时间（P = 0.04）来看，（BD）组的补救性吗啡镇痛明显低于（B）组。在最初12小时内，（BD）组的NAS明显低于（B）组（NAS 0 - P = 0.001，NAS 1 - P = 0.03）。添加右美托咪定改善了肠道蠕动，首次经口进食，但未观察到抗炎作用。
在供体肝切除术的TAP阻滞中，在手术插入的导管中向布比卡因中添加右美托咪定可减少吗啡消耗量，且未观察到抗炎作用。
