在妇科经脐单切口腹腔镜手术后的疼痛控制方面，超声引导下腹直肌鞘阻滞联合腹横肌平面阻滞优于单独使用任何一种阻滞。
A combination of ultrasound-guided rectus sheath and transversus abdominis plane blocks is superior to either block alone for pain control after gynecological transumbilical single incision laparoscopic surgery.
作者信息
Shimizu R, Kawahara R, Hanada R, Okuno S, Yamasaki K, Tamai Y, Kawahara H
出版信息
Clin Exp Obstet Gynecol. 2016;43(4):504-508.
PURPOSE
To investigate the efficacy of the combination of ultrasound-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks compared with TAP or RS block alone in gynecological single-incision laparoscopic surgery (SILS).
MATERIALS AND METHODS
Bilateral TAP blocks (Group A, n = 12), TAP and RS blocks (Group B, n = 12), and RS blocks (Group C, n = 12) with 40 ml ropivacaine/patient were performed for ovarian tumor SILS. The analgesic effects were evaluated using a numerical rating scale (NRS) at zero, six, 12, 24, and 48 hours post-surgery.
RESULTS
Umbilical pain on completion of general anesthesia was significantly less frequent in Group B (1/12) than Group A (7/12) (p = 0.03). The postoperative NRS scores were significantly lower in Group B than Group A at zero (p = 0.02) and six (p = 0.03) hours and Group C at zero (p = 0.001), six (p = 0.02), and 12 (p = 0.004) hours.
CONCLUSION
The combination of RS and TAP blocks reduced early postoperative pain compared with RS or TAP block alone for gynecological SILS.
目的
探讨超声引导下腹直肌鞘（RS）阻滞联合腹横肌平面（TAP）阻滞与单独使用TAP或RS阻滞相比，在妇科单切口腹腔镜手术（SILS）中的疗效。
材料与方法
对接受卵巢肿瘤SILS的患者，每组12例，分别进行双侧TAP阻滞（A组）、TAP联合RS阻滞（B组）和RS阻滞（C组），每例患者注射40 ml罗哌卡因。术后0、6、12、24和48小时采用数字评分量表（NRS）评估镇痛效果。
结果
B组（1/12）全麻结束时脐部疼痛的发生率显著低于A组（7/12）（p = 0.03）。术后NRS评分在术后0小时（p = 0.02）和6小时（p = 0.03）时，B组显著低于A组；在术后0小时（p = 0.001）、6小时（p = 0.02）和12小时（p = 0.004）时，B组显著低于C组。
结论
对于妇科SILS，与单独使用RS或TAP阻滞相比，RS联合TAP阻滞可减轻术后早期疼痛。
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