Ying Jun, Jiang Chunhui, Xu Chunjie, Liu Ye, Gu Lei
Jun Ying, Department of Anesthesiology, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, P.R. China.
Chunhui Jiang, Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, P.R. China.
Pak J Med Sci. 2023 Mar-Apr;39(2):518-523. doi: 10.12669/pjms.39.2.7062.
To evaluate the analgesic effect of transversus abdominis plane block (TAPB) on patients undergoing transanal total mesorectal excision (taTME).
Medical records of patients who were eligible to receive proctectomy surgery in Renji Hospital, Shanghai Jiao Tong University School of Medicine (From January 2019 to December 2021) were retrospectively reviewed. Propensity score matching (PSM) was applied to the included cases. A total of 120 cases were divided into three groups based on the different operation and anesthesia methods used. Group-A (Lap, n=40) included patients that underwent laparoscopic surgery under general anesthesia. Group- B (ta, n=40) included patients who received taTME surgery under general anesthesia. Group-C (ta+TAPB, n=40) included patients who received taTME surgery under general anesthesia combined with TAPB. The dosage of sufentanil, time of postoperative revival and extubation, anal exhaust time and other adverse events were recorded. Pain assessment using the visual analogue scale (VAS) was performed at 12, 24,48 and 72 hours after the operation.
There were no significant differences in the general parameters, operative conditions, and anesthetic administration between the three groups (P>0.05). The dosage of sufentanil was significantly reduced in Group-C, compared with Group-A and Group-B, with no difference between the groups A and B. There was no significant difference between the three groups in postoperative recovery time and extubation time. VAS score was lower in Group-C than Group-A and Group-B. This difference was more obvious in the early postoperative period and gradually diminished with time. VAS score became similar in all three groups 72 hours after the surgery.
Transanal total mesorectal excision was associated with less pain, compared to laparoscopic TME. TAPB with general anesthesia in patients undergoing taTME is safe and effective. It can significantly reduce the use of sufentanil and has optimal analgesic effect.
评估腹横肌平面阻滞（TAPB）对行经肛门全直肠系膜切除术（taTME）患者的镇痛效果。
回顾性分析上海交通大学医学院附属仁济医院2019年1月至2021年12月期间符合直肠切除术手术条件患者的病历。对纳入病例应用倾向评分匹配（PSM）。根据不同的手术和麻醉方法，将120例患者分为三组。A组（Lap，n = 40）包括在全身麻醉下接受腹腔镜手术的患者。B组（ta，n = 40）包括在全身麻醉下接受taTME手术的患者。C组（ta + TAPB，n = 40）包括在全身麻醉联合TAPB下接受taTME手术的患者。记录舒芬太尼用量、术后苏醒和拔管时间、肛门排气时间及其他不良事件。术后12、24、48和72小时采用视觉模拟评分法（VAS）进行疼痛评估。
三组患者的一般参数、手术情况和麻醉用药无显著差异（P>0.05）。与A组和B组相比，C组舒芬太尼用量显著减少，A组和B组之间无差异。三组患者术后恢复时间和拔管时间无显著差异。C组VAS评分低于A组和B组。这种差异在术后早期更为明显，并随时间逐渐减小。术后72小时三组VAS评分相似。
与腹腔镜全直肠系膜切除术相比，经肛门全直肠系膜切除术疼痛较轻。taTME患者全身麻醉联合TAPB安全有效。它可显著减少舒芬太尼的使用，并具有最佳镇痛效果。
