腹横肌平面阻滞和腰方肌阻滞在腹腔镜袖状胃切除术中的镇痛效果：一项随机双盲临床试验
Analgesic Efficacy of Transverse Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Sleeve Gastrectomy: A Randomized Double-Blinded Clinical Trial.
作者信息
Xue Qi, Chu Zhaoxia, Zhu Junjun, Zhang Xiaoyan, Chen Hong, Liu Wu, Jia Benli, Zhang Ye, Wang Yong, Huang Chunxia, Hu Xianwen
机构信息
Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China.
Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei City, Anhui Province, China.
出版信息
Pain Ther. 2022 Jun;11(2):613-626. doi: 10.1007/s40122-022-00373-1. Epub 2022 Mar 21.
INTRODUCTION
The analgesic effect and safety of transversus abdominis plane block (TAPB) is still controversial in various abdominal procedures. Quadratus lumborum block (QLB) has been considered to provide a widespread and long-lasting analgesic effect in gynecological surgeries. However, the analgesic effects of these two techniques in patients with extreme obesity undergoing laparoscopic sleeve gastrectomy (LSG) are still unknown.
METHODS
A total of 225 patients with obesity were randomly assigned to group TAPB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 μg kg), group QLB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 μg kg), or general anesthesia alone (GA, n = 73, 30 ml 0.9% saline). During the 48-h postoperative period, patients received continuous intravenous patient-controlled analgesia (PCA) containing sufentanil 2 μg kg, dexmedetomidine 2 μg kg, and granisetron 3 mg. The scores of visual analogue scale (VAS) in surgical incision and viscera, considering as the primary outcomes, were continuously recorded at postoperative 0, 0.5, 1, 2, 6, 12, 24, 48 h and discharge.
RESULTS
Comparing with patients in the GA group, VAS scores of incision and viscera were consistently reduced during the initial 6-12 h after LSG in TAPB and QLB groups, and they received less propofol and remifentanil (P < 0.001) as well. In the QLB group, patients had longer duration for the first rescue analgesia, and fewer requirements of the rescue analgesia within 24 h than the GA group (P < 0.05). In addition, there were fewer PCA requirements in QLB group than GA and TAPB groups (P < 0.05).
CONCLUSIONS
Ultrasound-guided transversus abdominis plane block and quadratus lumborum block could provide comparable analgesic effects for a laparoscopic sleeve gastrectomy in obese patients.
TRIAL REGISTRATION
Chinese Clinical Trial Registry; ChiCTR1800019236.
引言
腹横肌平面阻滞（TAPB）在各种腹部手术中的镇痛效果和安全性仍存在争议。腰方肌阻滞（QLB）被认为在妇科手术中能提供广泛且持久的镇痛效果。然而，这两种技术在极度肥胖患者接受腹腔镜袖状胃切除术（LSG）时的镇痛效果仍不明确。
方法
总共225例肥胖患者被随机分为TAPB组（n = 76，30 ml 0.33%罗哌卡因加右美托咪定1 μg/kg）、QLB组（n = 76，30 ml 0.33%罗哌卡因加右美托咪定1 μg/kg）或单纯全身麻醉组（GA，n = 73，30 ml 0.9%生理盐水）。在术后48小时内，患者接受含有舒芬太尼2 μg/kg、右美托咪定2 μg/kg和格拉司琼3 mg的持续静脉自控镇痛（PCA）。作为主要结局指标，在术后0、0.5、1、2、6、12、24、48小时及出院时持续记录手术切口和内脏的视觉模拟评分（VAS）。
结果
与GA组患者相比，TAPB组和QLB组在LSG术后最初6 - 12小时内切口和内脏的VAS评分持续降低，且他们使用的丙泊酚和瑞芬太尼也更少（P < 0.001）。在QLB组，患者首次补救镇痛的持续时间更长，且24小时内补救镇痛的需求比GA组少（P < 0.05）。此外，QLB组的PCA需求比GA组和TAPB组少（P < 0.05）。
结论
超声引导下的腹横肌平面阻滞和腰方肌阻滞可为肥胖患者的腹腔镜袖状胃切除术提供相当的镇痛效果。
试验注册
中国临床试验注册中心；ChiCTR1800019236。
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