He Jingxian, Qin Shuai, Wang Yuwen, Ye Qiuping, Wang Penglei, Zhang Ye, Wu Yun
Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Pain Res (Lausanne). 2024 Oct 16;5:1454665. doi: 10.3389/fpain.2024.1454665. eCollection 2024.
Abdominal surgery is a common surgical procedure that is frequently associated with substantial postoperative pain. However, rescue analgesia using opioids is associated with several adverse effects. The transversus abdominis plane block (TAPB) has been demonstrated to be effective as part of multimodal analgesia. This study aims to evaluate the effects of rescue analgesia using the TAPB following abdominal surgery.
Ninety patients undergoing abdominal surgery and reporting a numeric rating scale (NRS) score of cough pain ≥4 on the first postoperative day were randomized to receive either sufentanil or TAPB for rescue analgesia. Pain scores and arterial oxygen pressure (PaO) were evaluated before and after the administration of rescue analgesia. Sleep quality and gastrointestinal function were assessed postoperatively. The primary outcome was the degree of pain relief on coughing 30 min after the administration of rescue analgesia.
Patients of both groups reported a significantly reduced NRS score on coughing 30 min after receiving rescue analgesia ( < 0.001 for both groups). Notably, the degree of pain relief was significantly higher in the TAPB group than in the sufentanil group [median (interquartile range), -3 (-4 to -2) vs. -2 (-2 to -1), median difference = -1; 95% confidence interval, -2 to -1; < 0.001]. Moreover, patients in the TAPB group experienced less pain than those in the sufentanil group during the following 24 h. When evaluated, PaO increased significantly after rescue analgesia was administered in the TAPB group ( < 0.001); however, there were no significant intragroup differences in the sufentanil group ( = 0.129). Patients receiving the TAPB experienced better quality of sleep than those receiving sufentanil ( = 0.008), while no statistical differences in gastrointestinal function were observed between the two groups.
Rescue analgesia with the TAPB on the first postoperative day alleviated pain, enhanced oxygenation, and improved sleep quality in patients undergoing abdominal surgery; however, its effect on gastrointestinal function requires further research.
This study was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=170983, ChiCTR2200060285) on 26 May 2022: Patients were recruited during the period between 30 May 2022 and 14 February 2023, and a follow-up of the last enrolled patient was completed on 16 March 2023.
腹部手术是一种常见的外科手术，术后常伴有剧烈疼痛。然而，使用阿片类药物进行补救镇痛会带来多种不良反应。腹横肌平面阻滞（TAPB）已被证明作为多模式镇痛的一部分是有效的。本研究旨在评估腹部手术后使用TAPB进行补救镇痛的效果。
90例接受腹部手术且术后第一天咳嗽疼痛数字评分量表（NRS）得分≥4分的患者被随机分为两组，分别接受舒芬太尼或TAPB进行补救镇痛。在给予补救镇痛前后评估疼痛评分和动脉血氧分压（PaO）。术后评估睡眠质量和胃肠功能。主要结局是给予补救镇痛后30分钟咳嗽时的疼痛缓解程度。
两组患者在接受补救镇痛后30分钟咳嗽时的NRS评分均显著降低（两组均P<0.001）。值得注意的是，TAPB组的疼痛缓解程度显著高于舒芬太尼组[中位数（四分位间距），-3（-4至-2）对-2（-2至-1），中位数差异=-1；95%置信区间，-2至-1；P<0.001]。此外，TAPB组患者在接下来的24小时内疼痛程度低于舒芬太尼组。评估时，TAPB组给予补救镇痛后PaO显著升高（P<0.001）；然而，舒芬太尼组组内无显著差异（P=0.129）。接受TAPB的患者睡眠质量优于接受舒芬太尼的患者（P=0.008），而两组间胃肠功能无统计学差异。
术后第一天使用TAPB进行补救镇痛可减轻腹部手术患者的疼痛、改善氧合并提高睡眠质量；然而，其对胃肠功能的影响需要进一步研究。
本研究于2022年5月26日在中国临床试验注册中心（https://www.chictr.org.cn/showproj.html?proj=170983，ChiCTR2200060285）注册：患者于2022年5月30日至2023年2月14日期间招募，最后一名入组患者的随访于2023年3月16日完成。
