Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Institute of Anesthesia, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Pain Physician. 2023 Jan;26(1):21-27.
The postsurgical management of patients with ankylosing spondylitis is often only focused on the incision pain, and the pain caused by abdominal skin traction is paid little attention.
To explore the effectiveness of ultrasound-guided transversus abdominis plane block (TAPB) in treating abdominal skin tension pain after kyphosis surgery.
Randomized controlled trial.
This prospective study consecutively enrolled patients scheduled to undergo kyphosis correction surgery at the Department of Orthopedics of Xijing Hospital from March 2021 to December 2021.
The patients were randomized 1:1 to the TAPB and control groups. The Visual Analog Scale (VAS) for abdominal pain, Bruggrmann Comfort Scale (BCS), abdominal skin tension blisters, bed rest duration, length of hospitalization, and the use of patient-controlled analgesia pumps (PCAPs) were compared. The primary endpoint was pain alleviation at 24 hours after surgery.
Thirty-one patients were enrolled, without differences between the 2 groups regarding age, body mass index, preoperative kyphosis severity, operation duration, and blood loss. The TAPB group (n = 16) had lower abdominal VAS scores than the control group (n = 15) at 2, 4, 6, 8, and 12 hours after surgery (P < 0.05). The TAPB group had higher BCS scores than the control group at 4, 6, 8, and 12 hours after surgery (P < 0.05). The TAPB group used PCAPs less frequently than the control group after surgery (P < 0.001). The incidence of tension blisters in the TAPB group was numerically lower than that of the control group, but the difference was not statistically significant (18.8% vs 33.3%, P > 0.05).
The sample size of this study is small and a single-center study, there might be data bias.
In the first 24 hours after severe kyphosis surgery, TAPB can reduce the pain from abdominal skin tension and increase the comfort scores, but its effects on tension blisters remain to be further studied.
强直性脊柱炎患者术后管理通常仅关注切口疼痛，而对腹皮牵引引起的疼痛关注较少。
探讨超声引导腹横肌平面阻滞（TAPB）治疗脊柱后凸矫形术后腹皮紧张痛的效果。
随机对照试验。
本前瞻性研究连续纳入 2021 年 3 月至 2021 年 12 月在西京医院骨科行脊柱后凸矫正手术的患者。
患者按 1:1 随机分为 TAPB 组和对照组。比较两组患者术后腹痛视觉模拟评分（VAS）、Bruggrmann 舒适度评分（BCS）、腹皮紧张水疱、卧床时间、住院时间和患者自控镇痛泵（PCAP）使用情况。主要终点为术后 24 小时疼痛缓解情况。
共纳入 31 例患者，两组患者年龄、体重指数、术前后凸严重程度、手术时间和失血量差异无统计学意义。与对照组相比，TAPB 组患者术后 2、4、6、8 和 12 小时的 VAS 评分较低（P < 0.05）。TAPB 组患者术后 4、6、8 和 12 小时的 BCS 评分高于对照组（P < 0.05）。TAPB 组患者术后使用 PCAP 的频率低于对照组（P < 0.001）。TAPB 组张力水疱的发生率低于对照组，但差异无统计学意义（18.8%比 33.3%，P > 0.05）。
本研究样本量较小，为单中心研究，可能存在数据偏倚。
在严重脊柱后凸手术后的前 24 小时内，TAPB 可减轻腹皮紧张引起的疼痛，提高舒适度评分，但对张力水疱的影响仍需进一步研究。
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