腋中线腹横肌平面阻滞对子宫切除术应激反应的影响：一项随机对照安慰剂试验。

Mid-axillary transversus abdominis plane block and stress response after abdominal hysterectomy: A randomised controlled placebo trial.

机构信息

From the Department of Anaesthesiology (SI, AA, MQH, SA), Department of Pathology and Laboratory Medicine (AH) and Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan (AA).

出版信息

Eur J Anaesthesiol. 2021 Jul 1;38(7):768-776. doi: 10.1097/EJA.0000000000001413.

DOI:10.1097/EJA.0000000000001413

PMID:33399377

Abstract

BACKGROUND

The hormonal response to surgical trauma can have detrimental effects on patients. Transversus abdominis plane (TAP) block, which can improve analgesia after total abdominal hysterectomy (TAH) might attenuate the peri-operative stress response.

OBJECTIVE

To evaluate the ability of the TAP block to reduce stress response, opioid consumption and pain following TAH and multimodal analgesia.

DESIGN

Randomised, placebo-controlled double-blind study.

SETTING

The current study was conducted at a university hospital from July 2016 to September 2017.

PATIENTS

Fifty patients scheduled for TAH were included. Anaesthesia and postoperative analgesia were standardised.

INTERVENTION

After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral mid-axillary TAP block with 20 ml of bupivacaine 0.25% (Group T) or 0.9% saline (Group C).

MAIN OUTCOME MEASURES

Levels of free serum cortisol, metanephrine and normetanephrine at 60 min and 6, 12 and 24 h after surgical incision. Pain scores and opioid consumption during the first 24 h after surgery.

RESULTS

There was no statistically significant difference between the median [IQR] peri-operative levels of stress hormones and pain scores between groups. Compared with baseline value 9.90 [4.2 to 23.1], free serum median cortisol levels were significantly high at 6 h in Group T, 23.6 [10.1 to 42.9] P = 0.015 and Group C 23.6 [9.9 to 46.3] P = 0.014. Only Group C showed significant elevation from the baseline median levels of plasma metanephrine at 60 min, 52.8 [33.4 to 193.2] P = 0.001, 6 h, 92.70 [2.4 to 202.6] P = 0.005 and normetanephrine at 60 min 83.44 [28.98 to 114.86] P = 0.004, 6 h 78.62 [36.6 to 162.31] P = 0.0005 and 24 h 80.96 [8.6 to 110.5] P = 0.025. Mean ± SD opioid consumption was similar in both groups: 39.60 ± 14.87 in Group T vs. 43.68 ± 14.93 in Group C (P = 0.338).

CONCLUSION

Mid-axillary TAP block does not improve stress response and analgesia in patients undergoing TAH receiving multimodal analgesia.

TRAIL REGISTRATION

ClinicalTrial.gov identifier: NCT03443271.

摘要

背景

手术创伤引起的激素反应可能对患者造成不利影响。腹横肌平面（TAP）阻滞可以改善全腹部子宫切除术（TAH）后的镇痛效果，可能减轻围手术期应激反应。

目的

评估 TAP 阻滞减轻 TAH 和多模式镇痛后应激反应、阿片类药物消耗和疼痛的能力。

设计

随机、安慰剂对照、双盲研究。

地点

本研究于 2016 年 7 月至 2017 年 9 月在一所大学医院进行。

患者

50 例拟行 TAH 的患者入选。麻醉和术后镇痛标准化。

干预

麻醉诱导后，患者分为两组：双侧腋中线 TAP 阻滞，每侧 20ml 布比卡因 0.25%（T 组）或 0.9%生理盐水（C 组）。

主要观察指标

手术切口后 60min、6、12 和 24h 游离血清皮质醇、甲肾上腺素和去甲肾上腺素水平。术后 24h 内疼痛评分和阿片类药物消耗。

结果

两组围手术期应激激素和疼痛评分的中位数[IQR]无统计学差异。与基线值 9.90[4.2 至 23.1]相比，T 组术后 6h 游离血清皮质醇中位数明显升高，为 23.6[10.1 至 42.9]P=0.015，C 组为 23.6[9.9 至 46.3]P=0.014。只有 C 组在 60min 时血浆甲肾上腺素的基线水平显著升高，为 52.8[33.4 至 193.2]P=0.001，6h 时为 92.70[2.4 至 202.6]P=0.005，60min 时去甲肾上腺素为 83.44[28.98 至 114.86]P=0.004，6h 时为 78.62[36.6 至 162.31]P=0.0005，24h 时为 80.96[8.6 至 110.5]P=0.025。两组阿片类药物消耗量相似：T 组 39.60±14.87 与 C 组 43.68±14.93（P=0.338）。