Özfırat Nevzat, Akesen Selcan, Gören Suna, Gurbet Alp
Department of Anesthesiology and Reanimation, Bilecik Training and Research Hospital, Bilecik, Türkiye.
Department of Anesthesiology and Reanimation, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye.
Agri. 2025 Jan;37(1):1-9. doi: 10.14744/agri.2024.97947.
In this study, we aimed to compare the efficacy of two regional anesthesia methods, transversus abdominis plane (TAP) block and erector spinae plane (ESP) block, for intraoperative and postoperative pain relief in patients undergoing laparoscopic nephrectomy.
Fifty patients aged 18-80 years with American Society of Anesthesiologists (ASA) classification I-II scheduled for elective laparoscopic nephrectomy were included after ethical approval and informed consent. Patients were randomly assigned to either Group TAP (receiving TAP block) or Group ESP (receiving ESP block). Postoperatively, all patients received patient-controlled analgesia (PCA) with morphine. We evaluated intraoperative hemodynamics, additional opioid use, resting and coughing pain scores (Visual Analog Scales - VAS), time to first PCA dose, postoperative opioid consumption, rescue analgesic needs, opioid side effects, and patient and surgeon satisfaction.
In Group ESP, postoperative VAS scores at 8 hours and during the first mobilization were significantly lower (p=0.019, p=0.004, respectively) compared to Group TAP. Patient satisfaction was notably higher in Group ESP (p=0.014). However, other postoperative parameters were similar between the groups (p>0.05). These findings held true when considering only radical nephrectomies, with no differences in the assessed parameters between simple and partial nephrectomies.
In conclusion, both TAP and ESP blocks demonstrated comparable effectiveness in postoperative pain management for laparoscopic nephrectomies. Nevertheless, due to lower VAS scores during mobilization and higher patient satisfaction, the ESP block appears to be more effective for multimodal analgesia. Further research is required to comprehensively assess their efficacy in laparoscopic radical nephrectomies.
在本研究中，我们旨在比较两种区域麻醉方法，即腹横肌平面（TAP）阻滞和竖脊肌平面（ESP）阻滞，对接受腹腔镜肾切除术患者术中及术后疼痛缓解的效果。
纳入50例年龄在18 - 80岁、美国麻醉医师协会（ASA）分级为I - II级、计划行择期腹腔镜肾切除术的患者，经伦理批准并获得知情同意。患者被随机分为TAP组（接受TAP阻滞）或ESP组（接受ESP阻滞）。术后，所有患者均接受吗啡自控镇痛（PCA）。我们评估了术中血流动力学、额外阿片类药物的使用、静息和咳嗽时的疼痛评分（视觉模拟评分法 - VAS）、首次PCA给药时间、术后阿片类药物消耗量、补救镇痛需求、阿片类药物副作用以及患者和外科医生的满意度。
与TAP组相比，ESP组术后8小时及首次活动期间的VAS评分显著更低（分别为p = 0.019，p = 0.004）。ESP组患者满意度明显更高（p = 0.014）。然而，两组间其他术后参数相似（p>0.05）。仅考虑根治性肾切除术时这些结果依然成立，单纯性和部分性肾切除术之间评估参数无差异。
总之，TAP阻滞和ESP阻滞在腹腔镜肾切除术的术后疼痛管理中均显示出相当的有效性。然而，由于活动期间VAS评分更低且患者满意度更高，ESP阻滞似乎在多模式镇痛方面更有效。需要进一步研究以全面评估它们在腹腔镜根治性肾切除术中的疗效。
