双侧超声引导竖脊肌平面阻滞与腹横肌平面阻滞在全子宫切除术后的术后镇痛效果比较。
Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy.
机构信息
Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt.
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Alsharkia, Egypt.
出版信息
Pain Physician. 2020 Jul;23(4):375-382.
BACKGROUND
Transversus abdominis plane (TAP) blocks provide postoperative pain relief after various abdominal surgeries. Recently, erector spinae plane (ESP) block has obtained vast attention due to its simplicity and usage in truncal procedures.
OBJECTIVES
This study aims to compare the ultrasound-guided bilateral ESP block versus bilateral TAP block on postoperative analgesia after open total abdominal hysterectomy.
STUDY DESIGN
A prospective, double-blinded, randomized, controlled, clinical trial.
SETTING
Zagazig University Hospitals.
METHODS
After ending of surgical procedure and before reversing of the muscle relaxant, 48 women were randomly allocated into 2 equal groups: erector spinae (ES) group received bilateral ultrasound-guided ESP block with 20 mL of bupivacaine 0.375% plus 5 ug/mL adrenaline (1:200000) in each side at the level of T9, and transversus abdominis (TA) group received bilateral ultrasound-guided TAP block with the same volume of bupivacaine plus adrenaline.
RESULTS
Visual Analog Scale scores at 30 minutes, 2, 4, 6, 8, 12, 16, 20, and 24 hours were statistically significantly lower in the ES group compared with the TA group. The time for requirement of first morphine was highly statistically significantly prolonged in the ES group (14.81 ± 3.52 hours) compared with the TA group (10.58 ± 2.35 hours). The total amount of morphine consumption in 24 hours postoperatively was statistically significantly decreased in the ES group; P = 0.01. Incidence of postoperative nausea and vomiting was higher but statistically insignificant in the TA group than the ES group. There were statistically significant numbers of unsatisfied patients (4) in the TA group compared with the ES group (no patient).
LIMITATIONS
Sensorial evaluation of patients was not performed because both blocks had been done under general anesthesia but did not affect outcome. Therefore we recommend further studies comparing between both blocks.
CONCLUSIONS
Bilateral ultrasound-guided ESP block provides more potent and longer postoperative analgesia with less morphine consumption than TAP block after open total abdominal hysterectomy.
KEY WORDS
Abdominal hysterectomy, transversus abdominis plane block, erector spinae plane block, postoperative analgesia.
背景
腹横肌平面（TAP）阻滞可在各种腹部手术后提供术后镇痛。最近，由于其在躯干手术中的简单性和使用，竖脊肌平面（ESP）阻滞受到了广泛关注。
目的
本研究旨在比较超声引导下双侧 ESP 阻滞与双侧 TAP 阻滞对开腹全子宫切除术术后镇痛的效果。
研究设计
前瞻性、双盲、随机、对照、临床试验。
地点
宰加济格大学医院。
方法
手术结束后，在肌松剂逆转之前，将 48 名女性随机分为两组：竖脊肌（ES）组在 T9 水平双侧接受超声引导的 ESP 阻滞，每侧 20 毫升布比卡因 0.375%加 5ug/mL 肾上腺素（1:200000）；横腹肌（TA）组在相同容量的布比卡因加肾上腺素行双侧超声引导 TAP 阻滞。
结果
ES 组术后 30 分钟、2、4、6、8、12、16、20 和 24 小时的视觉模拟评分（VAS）明显低于 TA 组。ES 组首次需要吗啡的时间明显延长（14.81 ± 3.52 小时），TA 组为 10.58 ± 2.35 小时（P<0.001）。ES 组术后 24 小时吗啡总消耗量明显减少，P=0.01。TA 组术后恶心呕吐发生率较高，但差异无统计学意义。TA 组有 4 例（4 例）患者不满意，ES 组无患者不满意。
局限性
由于两种阻滞均在全身麻醉下进行，但不影响结果，因此未对患者进行感觉评估。因此，我们建议进一步研究比较这两种阻滞。
结论
与 TAP 阻滞相比，超声引导下双侧 ESP 阻滞可提供更强和更长时间的术后镇痛，并减少吗啡的消耗，用于开腹全子宫切除术。
关键词
腹部子宫切除术，横腹肌平面阻滞，竖脊肌平面阻滞，术后镇痛。
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