Emile Sameh Hany, Elfeki Hossam, Elbahrawy Khaled, Sakr Ahmad, Shalaby Mostafa
General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
Department of Anesthesia, Mansoura University Hospitals, Mansoura University, Egypt.
Int J Surg. 2022 May;101:106639. doi: 10.1016/j.ijsu.2022.106639. Epub 2022 Apr 27.
Transversus abdominis plane (TAP) block is an effective modality for the control of immediate postoperative pain. The present randomized trial aimed to assess the efficacy of ultrasound-guided subcostal TAP (USTAP) and laparoscopic subcostal TAP (LSTAP) block as compared to standard care without TAP block after laparoscopic cholecystectomy.
This was a prospective, randomized, controlled trial on patients who underwent laparoscopic cholecystectomy. Patients were equally randomized to one of three groups: USTAP, LSTAP, and control group (no TAP block). The main outcome measures were pain scores and analgesic consumption within the first 24 h postoperatively, postoperative nausea and vomiting (PONV), time to ambulation, time to first flatus, and adverse effects of TAP block.
The trial included 110 patients (90% females) with a mean age of 40.9 ± 11.7 years. Both USTAP and LSTAP block groups were associated with significantly lower pain scores at 2, 6, 12, and 24 h postoperatively, lower cumulative dose of paracetamol, less PONV, and shorter time to flatus than the control group. USTAP and LSTAP block were associated with similar pain scores at all time points, similar analgesic requirements, a similar incidence of PONV, and comparable time to first ambulation and time to first flatus. No adverse effects related to TAP block were recorded.
TAP block is a safe and effective method for pain control and improving recovery after laparoscopic cholecystectomy. Both USTAP and LSTAP blocks were equally effective in terms of pain relief, analgesic requirements, PONV, return of bowel function, and time to ambulation.
腹横肌平面（TAP）阻滞是控制术后即刻疼痛的一种有效方式。本随机试验旨在评估超声引导下肋缘下TAP（USTAP）阻滞和腹腔镜肋缘下TAP（LSTAP）阻滞与腹腔镜胆囊切除术后不进行TAP阻滞的标准护理相比的疗效。
这是一项针对接受腹腔镜胆囊切除术患者的前瞻性、随机、对照试验。患者被随机分为三组之一：USTAP组、LSTAP组和对照组（不进行TAP阻滞）。主要观察指标为术后24小时内的疼痛评分、镇痛药用量、术后恶心呕吐（PONV）、下床活动时间、首次排气时间以及TAP阻滞的不良反应。
该试验纳入了110例患者（90%为女性），平均年龄为40.9±11.7岁。USTAP组和LSTAP组在术后2、6、12和24小时的疼痛评分均显著低于对照组，对乙酰氨基酚的累积剂量更低，PONV更少，排气时间更短。USTAP组和LSTAP组在所有时间点的疼痛评分、镇痛需求、PONV发生率、首次下床活动时间和首次排气时间均相似。未记录到与TAP阻滞相关的不良反应。
TAP阻滞是腹腔镜胆囊切除术后控制疼痛和促进恢复的一种安全有效的方法。USTAP阻滞和LSTAP阻滞在缓解疼痛、镇痛需求、PONV、肠道功能恢复和下床活动时间方面同样有效。
