超声引导下肋缘下腹横肌平面阻滞的皮肤感觉阻滞区域：一项观察性研究。

Cutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block: an observational study.

机构信息

Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerod, Denmark

Graduate School, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

出版信息

Reg Anesth Pain Med. 2024 Apr 2;49(4):289-292. doi: 10.1136/rapm-2023-104753.

DOI:10.1136/rapm-2023-104753

PMID:37640451

Abstract

BACKGROUND AND OBJECTIVES

The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach.

METHODS

Thirty patients undergoing elective laparoscopic cholecystectomy received a subcostal US-TAP with 20 mL 2.5 mg/mL ropivacaine bilaterally. Measurements were performed 150 min after block application. The CSBA was mapped using cold sensation and a sterile marker, photodocumented, and transferred to a transparency. The area of the CSBA was calculated from the transparencies.

RESULTS

The median CSBA of the subcostal US-TAP was 174 cm (IQR 119-219 cm; range 52-398 cm). In all patients, the CSBA had a periumbilical distribution. In 42 of the 60 (70%) unilateral blocks, the CSBA had both an epigastric and infraumbilical component; in 12 of the 60 (20%) unilateral blocks, it covered only the epigastrium; and in 4 of the 60 (7%) unilateral blocks, it had only an infraumbilical distribution. No CSBA was found in 2 of the 60 (3%) unilateral blocks. In none of the patients did the CSBA cover the abdominal wall lateral to a vertical line through the anterior superior iliac spine.

CONCLUSION

The subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.

摘要

背景与目的

腹横肌平面阻滞（TAP）可通过不同的方法实施，从而产生不同的皮肤镇痛分布。本研究旨在评估经超声引导下肋缘下入路 TAP（US-TAP）后皮肤感觉阻滞面积（CSBA）。

方法

30 例行择期腹腔镜胆囊切除术的患者接受双侧肋缘下入路 US-TAP，每侧注入 20mL2.5mg/mL 罗哌卡因。在阻滞后 150min 进行测量。使用冷感觉和无菌标记物绘制 CSBA 图，拍照记录，并转移到透明胶片上。从透明胶片上计算 CSBA 的面积。

结果

肋缘下入路 US-TAP 的 CSBA 中位数为 174cm（IQR 119-219cm；范围 52-398cm）。在所有患者中，CSBA 均呈脐周分布。在 60 个单侧阻滞中有 42 个（70%），CSBA 既有上腹部分布，也有脐下分布；在 12 个单侧阻滞中有 60 个（20%），仅覆盖上腹；在 4 个单侧阻滞中有 60 个（7%），仅分布于脐下。在 60 个单侧阻滞中有 2 个（3%）未发现 CSBA。在没有患者的 CSBA 覆盖经髂前上棘前垂线的腹壁外侧。