Chatrath Veena, Khetarpal Ranjana, Kumari Heena, Kaur Harjinder, Sharma Anu
Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
Anesth Essays Res. 2018 Apr-Jun;12(2):349-354. doi: 10.4103/aer.AER_16_18.
Multimodal analgesia is currently recommended for effective postoperative analgesia.
The aim of this study is to compare the efficacy of transversus abdominis plane (TAP) block with intermittent transcutaneous electrical nerve stimulation (TENS) in postoperative patients after infraumbilical surgeries under spinal anesthesia with respect to postoperative analgesia, rescue analgesia, hemodynamic changes, block characteristics, nausea/vomiting score, sedation score, adverse effects, and patient satisfaction.
This was a prospective, observational study randomized controlled trial.
A total of 60 American Society of Anesthesiologists physical status Classes I and II patients of 20-60 years scheduled for infraumbilical surgeries were randomized by a computer-generated list into two groups of 30 each, to receive either TAP Block (Group TAP: 15 ml of 0.25% levobupivacaine on each side of abdomen) or TENS (Group TENS: TENS with frequency of 50 Hz and intensity of electrical stimulation 9-12 mA, continued for 30 min every 2 h till 24 h). The primary outcome was to compare the postoperative analgesia as assessed using visual analog scale score. Secondary objectives were to compare rescue analgesia, nausea/vomiting score, sedation score, the block characteristics, adverse effects, hemodynamic changes, and patient satisfaction.
Student's -test, Chi-square test as applicable and Statistical Package for Social Sciences (version 23.0, 2017, SPSS Inc., Chicago, IL, USA) were used.
Time to the first analgesic requirement was 12.87 ± 4.72 h in Group TAP and 9.93 ± 3.63 h in Group TENS ( < 0.008), the difference between two groups was significant.
TAP block is better modality due to ease of application and prolonged analgesia.
目前推荐采用多模式镇痛以实现有效的术后镇痛。
本研究旨在比较腹横肌平面(TAP)阻滞与间歇性经皮电神经刺激(TENS)在脊髓麻醉下脐下手术术后患者的术后镇痛、补救性镇痛、血流动力学变化、阻滞特征、恶心/呕吐评分、镇静评分、不良反应及患者满意度方面的疗效。
这是一项前瞻性观察性随机对照试验。
总共60例年龄在20 - 60岁、美国麻醉医师协会身体状况分级为I级和II级、计划进行脐下手术的患者,通过计算机生成的列表随机分为两组,每组30例,分别接受TAP阻滞(TAP组:腹部两侧各注射15 ml 0.25%左旋布比卡因)或TENS(TENS组:频率为50 Hz、电刺激强度为9 - 12 mA的TENS,每2小时持续30分钟,直至24小时)。主要结局是比较使用视觉模拟量表评分评估的术后镇痛情况。次要目标是比较补救性镇痛、恶心/呕吐评分、镇静评分、阻滞特征、不良反应、血流动力学变化及患者满意度。
采用学生t检验、适用时的卡方检验以及社会科学统计软件包(2017年第23.0版,SPSS公司,美国伊利诺伊州芝加哥)。
TAP组首次需要镇痛的时间为12.87 ± 4.72小时,TENS组为9.93 ± 3.63小时(P < 0.008),两组之间差异显著。
由于应用简便且镇痛时间延长,TAP阻滞是更好的方式。