超声引导腹横肌平面阻滞联合腹直肌鞘阻滞对腹腔镜辅助直肠癌根治术患者的影响：一项随机、双盲、安慰剂对照试验。

Effect of ultrasound-guided transversus abdominis plane block with rectus sheath block on patients undergoing laparoscopy-assisted radical resection of rectal cancer: a randomized, double-blind, placebo-controlled trial.

机构信息

Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, People's Republic of China.

Department of Anesthesiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.

出版信息

BMC Anesthesiol. 2021 Mar 24;21(1):89. doi: 10.1186/s12871-021-01295-9.

BACKGROUND

Many patients complain of pain following laparoscopic surgery. Clinicians have used ultrasound-guided posterior transversus abdominis plane block (TAPB) and rectus sheath block (RSB) for multimodal analgesia after surgery. We investigated the analgesic effects of US-guided posterior TAPB with RSB on postoperative pain following laparoscopy-assisted radical resection of early-stage rectal cancer.

METHODS

Seventy-eight adults scheduled for laparoscopy-assisted radical resection of rectal cancer were enrolled in this double-blind placebo-controlled trial. Patients were randomized into 3 groups: the TR Group underwent US-guided bilateral posterior TAPB (40 mL 0.33% ropivacaine) with RSB (20 mL 0.33% ropivacaine); the T Group underwent US-guided bilateral posterior TAPB alone; and the Control Group received saline alone. All patients also had access to patient-controlled intravenous analgesia (PCIA) with sufentanil. The primary outcome was postoperative sufentanil consumption at 0-24, 24-48, and 48-72 h. The secondary outcomes were postoperative pain intensity and functional activity score at rest and while coughing for the same three time periods, intraoperative medication dosage, use of rescue analgesia, recovery parameters, and adverse effects.

RESULTS

The three groups had no significant differences in baseline demographic and perioperative data, use of intraoperative medications, recovery parameters, and adverse effects. The TR group had significantly lower postoperative use of PCIA and rescue analgesic than in the other two groups (P < 0.05), but the Control Group and T Group had no significant differences in these outcomes.

CONCLUSIONS

Postoperative US-guided posterior TAPB with RSB reduced postoperative opioid use in patients following laparoscopy-assisted radical resection of rectal cancer.

TRIAL REGISTRATION

The trial was registered with chictr.org (ChiCTR2000029326) on January 25, 2020.

背景

许多腹腔镜手术后的患者会出现疼痛。临床医生已将超声引导下腹横肌平面阻滞（TAPB）和腹直肌鞘阻滞（RSB）用于术后多模式镇痛。我们研究了超声引导下 TAPB 联合 RSB 对腹腔镜辅助早期直肠癌根治术后疼痛的镇痛效果。

方法

本双盲安慰剂对照试验纳入了 78 例拟行腹腔镜辅助直肠癌根治术的成年人。患者随机分为 3 组：TR 组接受超声引导下双侧 TAPB（40mL0.33%罗哌卡因）联合 RSB（20mL0.33%罗哌卡因）；T 组仅接受超声引导下双侧 TAPB；对照组仅接受生理盐水。所有患者还均接受舒芬太尼患者自控静脉镇痛（PCIA）。主要结局是术后 0-24、24-48 和 48-72h 的舒芬太尼消耗量。次要结局是术后休息和咳嗽时的疼痛强度和功能活动评分，以及相同三个时间段的术中药物剂量、补救性镇痛的使用、恢复参数和不良反应。