Oliţă Mihaela Roxana, Eftimie Mihai Adrian, Vrabie Elena-Mihaela, Mirea Liliana Elena, Tomescu Dana Rodica
Chirurgia (Bucur). 2025 Aug;120(4):416-425. doi: 10.21614/chirurgia.3134.
Laparoscopic resection has become the standard surgical technique in treating colorectal cancer. This approach has many advantages over open surgery such as: faster recovery, lower postoperative pain with reduced postoperative pain scores and opioid requirements and shorter hospital-stay. Improving postoperative pain management by performing transversus abdominis plane block enhances some of the benefits of laparoscopic colorecat surgery. The aim of our study was to emphasize the role and the benefits of transversus abdominis plane block after laparoscopic colorectal resection. Material and This prospective observational cohort study was conducted at the Fundeni Clinical Institute in Bucharest, Romania, and received ethical approval from the institutional Ethics Committee. We included adult patients aged 18 to 85 years, classified as ASA physical status I-III, undergoing elective laparoscopic colorectal surgery. Exclusion criteria comprised contraindications to TAP block, the necessity for additional analgesic interventions, and specific medical conditions. The TAP block was performed under ultrasound guidance, utilizing 0.25% ropivacaine administered bilaterally. Postoperative pain was evaluated through the Visual Analog Scale (VAS) at intervals of 1, 2, 4, 8, 12, and 48 hours. Analgesic consumption was meticulously recorded, focusing on opioids, paracetamol, tramadol, and Neodolpasse. The findings indicated a significant reduction in paracetamol consumption within the TAP block group, evidenced by a p-value of 0.011, which suggests lower analgesic requirements compared to the control group. Furthermore, the median time to the first analgesic request was significantly prolonged in the TAP block group, recorded at 8 hours (IQR: 0.00) versus 5 hours (IQR: 1.00) in the control group, with a p-value of 0.001. These results imply that the TAP block not only enhances analgesia but also extends the interval before additional analgesics are necessary. The TAP block demonstrates substantial efficacy in multimodal analgesia, significantly reducing both opioid and non-opioid analgesic consumption while improving patient comfort and satisfaction. These findings emphasize the TAP block's effectiveness in addressing somatic pain in the abdominal region. Integrating regional anesthesia techniques into standard surgical protocols is essential for optimizing patient outcomes. Future randomized controlled trials are warranted to further validate these findings and elucidate the underlying mechanisms involved.
腹腔镜切除术已成为治疗结直肠癌的标准手术技术。与开放手术相比，这种方法有许多优点，例如：恢复更快、术后疼痛减轻，术后疼痛评分和阿片类药物需求量降低，住院时间缩短。通过实施腹横肌平面阻滞改善术后疼痛管理可增强腹腔镜结直肠手术的一些益处。我们研究的目的是强调腹腔镜结直肠切除术后腹横肌平面阻滞的作用和益处。材料与方法 这项前瞻性观察性队列研究在罗马尼亚布加勒斯特的Fundeni临床研究所进行，并获得了机构伦理委员会的伦理批准。我们纳入了年龄在18至85岁之间、ASA身体状况为I - III级、接受择期腹腔镜结直肠手术的成年患者。排除标准包括腹横肌平面阻滞的禁忌证、需要额外的镇痛干预以及特定的医疗状况。腹横肌平面阻滞在超声引导下进行，双侧注射0.25%的罗哌卡因。术后疼痛通过视觉模拟量表（VAS）在1、2、4、8、12和48小时的间隔时间进行评估。仔细记录镇痛药物的消耗量，重点关注阿片类药物、对乙酰氨基酚、曲马多和奈多罗米。研究结果表明，腹横肌平面阻滞组对乙酰氨基酚的消耗量显著减少，p值为0.011，这表明与对照组相比，镇痛药物需求量更低。此外，腹横肌平面阻滞组首次镇痛需求的中位时间显著延长，记录为8小时（四分位间距：0.00），而对照组为5小时（四分位间距：1.00），p值为0.001。这些结果意味着腹横肌平面阻滞不仅增强了镇痛效果，还延长了需要额外镇痛药物的间隔时间。腹横肌平面阻滞在多模式镇痛中显示出显著疗效，显著减少了阿片类和非阿片类镇痛药物的消耗量，同时提高了患者的舒适度和满意度。这些发现强调了腹横肌平面阻滞在解决腹部区域躯体疼痛方面的有效性。将区域麻醉技术纳入标准手术方案对于优化患者预后至关重要。未来有必要进行随机对照试验，以进一步验证这些发现并阐明其中涉及的潜在机制。
