Anesthesia and Intensive Care at the Neuroscience Department, San Camillo Forlanini Hospital, Rome, Italy.
Department of Anesthesiology, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy.
Pain Med. 2020 Feb 1;21(2):378-386. doi: 10.1093/pm/pnz214.
Use of a locoregional analgesia technique, such as the ultrasound-guided transversus abdominis plane block (TAPb), can improve postoperative pain management. We investigated the role of TAPb in robotic partial nephrectomy, a surgery burdened by severe postoperative pain.
In this prospective trial, patients with American Society of Anesthesiologists class I-III physical status undergoing robotic partial nephrectomy were randomly assigned to standard general anesthetic plus ultrasound-guided TAPb (TAP group) or sole standard general anesthetic (NO-TAP group). The primary end point was morphine consumption 24 hours after surgery. Secondary outcomes were postoperative nausea and vomiting in the first 24 hours, sensitivity, and acute and chronic pain, as measured by multiple indicators.
A total of 96 patients were evaluated: 48 patients in the TAP group and 48 in the NO-TAP group. Median morphine consumption after 24 hours was higher in the NO-TAP group compared with the TAP group (14.1 ± 4.5 mg vs 10.6 ± 4.6, P < 0.008). The intensity of acute somatic pain and the presence of chronic pain at three and six months were higher in the NO-TAP group.
Our results show that TAPb can significantly reduce morphine consumption and somatic pain, but not visceral pain. TAPb reduced the incidence of chronic pain.
使用局部区域镇痛技术，如超声引导腹横肌平面阻滞（TAPb），可以改善术后疼痛管理。我们研究了 TAPb 在机器人辅助部分肾切除术（一种术后疼痛严重的手术）中的作用。
在这项前瞻性试验中，ASA 分级 I-III 级的患者接受机器人辅助部分肾切除术，随机分为标准全身麻醉加超声引导 TAPb（TAP 组）或单纯标准全身麻醉（NO-TAP 组）。主要终点是术后 24 小时吗啡消耗量。次要结果是术后 24 小时内恶心和呕吐的发生率、敏感性以及通过多项指标测量的急性和慢性疼痛。
共评估了 96 例患者：TAP 组 48 例，NO-TAP 组 48 例。NO-TAP 组术后 24 小时吗啡消耗量中位数高于 TAP 组（14.1±4.5mg 比 10.6±4.6mg，P<0.008）。NO-TAP 组急性躯体疼痛强度和术后 3 个月和 6 个月慢性疼痛的发生率更高。
我们的结果表明，TAPb 可显著减少吗啡用量和躯体疼痛，但不能减少内脏疼痛。TAPb 降低了慢性疼痛的发生率。
