Osaheni O, Idehen H O, Imarengiaye C O
Department of Anaesthesiology, University of Benin Teaching Hospital Benin City, Edo State, Nigeria.
Niger J Clin Pract. 2020 Nov;23(11):1523-1529. doi: 10.4103/njcp.njcp_162_19.
Acute postoperative pain after myomectomy can impair patient function. Like all other postoperative pain, it is a challenge requiring solution, particularly in developing countries. Ultrasound-guided transversus abdominis plane (TAP) block and wound infiltration (WI) are both known to be effective in managing postoperative pain. It is not certain if transversus abdominis plain block would be superior to wound infiltration. Aims: It was hypothesized that the TAP block has similar analgesic effectiveness to wound infiltration.
This study was a randomized controlled trial involving, seventy-four (74) patients scheduled for myomectomy at the University of Benin Teaching Hospital Benin City, Nigeria under the subarachnoid block, which were randomized into TAP and WI group preoperatively. The ultrasound-guided bilateral TAP block group and wound infiltration group (subfascial and subcutaneous infiltration) each used 40 mL of 0.25% of plain bupivacaine to achieve postoperative analgesia. The time to first analgesic request, numerical pain rating scale (NRS) score at rest, and movement were assessed. Data were analyzed using SPSS version 16 (Chicago Il, USA).
The time to first analgesic request was significantly delayed in the TAP block group compared to the wound infiltration group [240 (131, 375) min vs 170 (128, 187) minutes. P = 0.006]. The proportions of patients with NRS score ≤3 at the time of first analgesic requests were significantly more in the TAP block group (P < 0.001). The analgesic consumed by the TAP block group was significantly low compared to the WI group. There were no incidences of complications due to TAP block or wound infiltration.
TAP block provided a longer duration of analgesia and a clinically superior quality of analgesia to wound infiltration.
子宫肌瘤切除术后的急性疼痛会影响患者的功能。与所有其他术后疼痛一样，这是一个需要解决的挑战，尤其是在发展中国家。超声引导下的腹横肌平面（TAP）阻滞和伤口浸润（WI）均已知对术后疼痛管理有效。目前尚不确定腹横肌平面阻滞是否优于伤口浸润。目的：假设TAP阻滞与伤口浸润具有相似的镇痛效果。
本研究为一项随机对照试验，纳入了74例计划在尼日利亚贝宁城贝宁大学教学医院接受蛛网膜下腔阻滞下子宫肌瘤切除术的患者，术前将其随机分为TAP组和WI组。超声引导下双侧TAP阻滞组和伤口浸润组（筋膜下和皮下浸润）均使用40 mL 0.25%的布比卡因原液来实现术后镇痛。评估首次镇痛需求时间、静息和活动时的数字疼痛评分量表（NRS）得分。使用SPSS 16版软件（美国伊利诺伊州芝加哥）进行数据分析。
与伤口浸润组相比，TAP阻滞组的首次镇痛需求时间显著延迟[240（131，375）分钟对170（128，187）分钟。P = 0.006]。首次镇痛需求时NRS评分≤3分的患者比例在TAP阻滞组显著更高（P < 0.001）。与WI组相比，TAP阻滞组消耗的镇痛药显著更少。未发生因TAP阻滞或伤口浸润导致的并发症。
与伤口浸润相比，TAP阻滞提供了更长的镇痛持续时间和临床上更优的镇痛质量。
