Guo Jian-Guo, Li Hui-Ling, Pei Qing-Qing, Feng Zhi-Ying
Department of Anesthesiology and Pain Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qing Chun Road, Hangzhou, 310003, People's Republic of China.
Department of Anesthesiology and Pain Medicine, the First People's Hospital of Beilun District, Ningbo, China.
BMC Anesthesiol. 2018 Apr 10;18(1):36. doi: 10.1186/s12871-018-0499-3.
Conventional perioperative analgesic modalities (e.g. opioids, epidural analgesia) have their own drawbacks, which limit their clinical application. This study investigated the opioid-sparing effectsof the oblique subcostal transversus abdominis plane (OSTAP) blockade with ropivacaine for the patients undergoing open liver resection with a Mercedes incision.
126 patients who were scheduled for open liver resection were enrolled in this study. Patients were randomly assigned to receive bilateral ultrasound-guided OSTAPblocks with either 0.375% ropivacaine (groupT) or 0.9% isotonic saline (group C). Both groups also received intravenous patient-controlled analgesia and intravenous 40 mg parecoxib every 12 h for a total of 3 days. Preoperative and intraoperative parameters, plus intraoperative and postoperative cumulative sufentanil consumption, were recorded.
70 patients were enrolled in the study finally. There were no significant differences between the two groups with respect to preoperative parameters, and surgical and anesthetic characteristics. The intraoperative sufentanil use, cumulative sufentanil consumption at 5 min after extubation, 2 h, 4 h,12 h and 24 h after operation in group T was significantly less than that in group C (P = 0.001, 0.001, 0.000, 0.000, 0.001 and 0.044, respectively). Compared with group C, postoperative NRS pain scores at rest were significantly lower at 2 h and 4 h postoperatively in group T (P = 0.04and 0.02, respectively); NRS scores at the time of coughing were also significantly lower in group T than in group C at all time points except 5 min after extubation (all P < 0.001). Furthermore, compared with group C, the number of intraoperative vasodilator use, the extubation time and the incidence of nausea was reduced in group T.
Ultrasound-guided OSTAP block with ropivacaine can significantly decrease the perioperative cumulative dosage of analgesics and improve analgesic effect without obvious side effects for the patients who underwent an open liver resection with Mercedes incision when compared tothe ultrasound-guided OSTAP block with saline.
The study protocol was registered at http://www.chictr.org.cn (ChiCTR-TRC- 14004827) on February 19, 2014.
传统的围手术期镇痛方式（如阿片类药物、硬膜外镇痛）都有其自身的缺点，这限制了它们的临床应用。本研究探讨了用罗哌卡因进行肋下斜行腹横肌平面（OSTAP）阻滞对采用Mercedes切口行肝切除术患者的阿片类药物节省效应。
126例计划行肝切除术的患者纳入本研究。患者被随机分配接受双侧超声引导下OSTAP阻滞，其中一组注射0.375%罗哌卡因（T组），另一组注射0.9%等渗盐水（C组）。两组均接受静脉自控镇痛，并每12小时静脉注射40mg帕瑞昔布，共3天。记录术前和术中参数，以及术中和术后舒芬太尼的累计用量。
最终70例患者纳入研究。两组在术前参数、手术和麻醉特征方面无显著差异。T组术中舒芬太尼用量、拔管后5分钟、术后2小时、4小时、12小时和24小时的舒芬太尼累计用量均显著低于C组（P分别为0.001、0.001、0.000、0.000、0.001和0.044）。与C组相比，T组术后静息时NRS疼痛评分在术后2小时和4小时显著更低（P分别为0.04和0.02）；除拔管后5分钟外，T组咳嗽时NRS评分在所有时间点也显著低于C组（所有P均<0.001）。此外，与C组相比，T组术中血管扩张剂使用次数、拔管时间和恶心发生率均降低。
与超声引导下用盐水进行OSTAP阻滞相比，超声引导下用罗哌卡因进行OSTAP阻滞可显著降低采用Mercedes切口行肝切除术患者围手术期镇痛药物的累计用量，并改善镇痛效果，且无明显副作用。
该研究方案于2014年2月19日在http://www.chictr.org.cn（ChiCTR-TRC-14004827）注册。
