Zhang Linlin, Jia Zhen, Gao Tianyu, Wang Yigang, Zhao Yuying, Li Jing, Yu Yonghao, Li Qing, Wang Guolin
Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Research Institute of Anesthesiology, Tianjin, China.
Front Mol Neurosci. 2023 Jan 25;16:967917. doi: 10.3389/fnmol.2023.967917. eCollection 2023.
Incorporation of transversus abdominis plane (TAP) block into multimodal analgesia has been emphasized in Enhanced Recovery protocols (ERPs). However, benefit is limited in clinical practice. A potential explanation is the short duration of analgesia of standard local anesthetics. Herein, this randomized, double-blind, controlled trial evaluated whether TAPB with long-acting compound lidocaine hydrochloride injection reduces postoperative pain.
164 patients undergoing elective gynecological laparotomy under sevoflurane anesthesia randomly received ultrasound-guided TAP block with either saline, or ropivacaine, or compound lidocaine before anesthesia induction. The postoperative pain intensity (primary outcome) was evaluated by pain 11-point numerical rating scale. We also recorded sufentanil consumptions, time to first flatus, side-effects and hospital stay after surgery.
We reported that pain scores at rest at postoperative 3h in group 0.375% ropivacaine was lower than that in group saline [mean 2.4 (SD 1.2) 3.0 (1.0), = 0.036]. Compared with saline, 0.4% and 0.6% compound lidocaine caused lower pain scores at rest at postoperative 12h [2.8 (0.9) 2.1 (0.9) and 2.0 (0.9), = 0.016 and = 0.006]. Sufentanil usage for the first postoperative 48h was lower in group 0.6% compound lidocaine than group saline [24.2 (5.4) 45.6 (7.5) µg, < 0.001]. Time to first flatus and hospital stay after surgery was shortest and the incidence of postoperative nausea was lowest in patients receiving 0.6% compound lidocaine.
TAP block with 0.6% compound lidocaine hydrochloride injection attenuates postoperative pain, reduces opioid consumption, accelerates gastrointestinal function recovery, and shortens length of hospital stay in patients after gynecological laparotomy.
ClinicalTrials.gov, identifier: NCT04938882.
在加速康复方案（ERP）中，腹横肌平面（TAP）阻滞已被强调纳入多模式镇痛。然而，在临床实践中其益处有限。一个可能的解释是标准局麻药的镇痛持续时间较短。在此，这项随机、双盲、对照试验评估了使用长效复方盐酸利多卡因注射液进行TAP阻滞是否能减轻术后疼痛。
164例在七氟醚麻醉下行择期妇科剖腹手术的患者在麻醉诱导前随机接受超声引导下的TAP阻滞，分别注射生理盐水、罗哌卡因或复方利多卡因。术后疼痛强度（主要结局）通过疼痛11点数字评分量表进行评估。我们还记录了舒芬太尼用量、首次排气时间、副作用及术后住院时间。
我们报告0.375%罗哌卡因组术后3小时静息时疼痛评分低于生理盐水组[均值2.4（标准差1.2）对3.0（1.0），P = 0.036]。与生理盐水组相比，0.4%和0.6%复方利多卡因组术后12小时静息时疼痛评分更低[2.8（0.9）对2.1（0.9）和2.0（0.9），P = 0.016和P = 0.006]。0.6%复方利多卡因组术后48小时内舒芬太尼用量低于生理盐水组[24.2（5.4）对45.6（7.5）μg，P < 0.001]。接受0.6%复方利多卡因的患者首次排气时间和术后住院时间最短，术后恶心发生率最低。
0.6%复方盐酸利多卡因注射液进行TAP阻滞可减轻妇科剖腹手术后患者的术后疼痛，减少阿片类药物用量，加速胃肠功能恢复，并缩短住院时间。
ClinicalTrials.gov，标识符：NCT04938882
