The analgesic efficacy of oblique subcostal transversus abdominis plane block after laparoscopic hysterectomy A randomized, controlled, observer-blinded study
The analgesic efficacy of oblique subcostal transversus abdominis plane block after laparoscopic hysterectomy A randomized, controlled, observer-blinded study
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DOI：
10.1097/md.0000000000013994
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发表时间：
2019-01-01
期刊：
影响因子：
1.6
通讯作者：
Demirbilek, Semra Gumus
中科院分区：
文献类型：
--
作者：
Toker, Melike Korkmaz;Altiparmak, Basak;Demirbilek, Semra Gumus
背景资料：我们的目的是评估超声（US）引导下斜肋下腹横平面（OSTAP）阻滞是否会改善腹腔镜子宫切除术后的术后疼痛评分并减少曲马多的消耗。方法：美国麻醉医师协会I、II或III级的66名女性患者，年龄在18 - 65岁之间，因良性妇科疾病而计划进行腹腔镜子宫切除术的患者被纳入这项随机、对照、双盲试验。60名患者完成了研究。患者随机分为2组。在OSTAP组中，患者接受了40 mL 0.375%布比卡因的双侧OSTAP阻滞，而在Sham组中，患者接受了40 mL 0.9%盐水的US引导下双侧OSTAP阻滞。所有患者均于术后第24小时接受曲马多自控镇痛。假手术组的患者接受了超声引导下双侧OSTAP，并使用40 mL 0.9%生理盐水。主要结局是24小时曲马多消耗量。次要结果包括运动过程中的视觉模拟量表（VAS）评分，术后1，4，12小时的曲马多消耗量，以及术后24小时的恶心评分。OSTAP组在术后24小时曲马多消耗量有统计学显著减少（平均差异22 mg，95%置信区间-38.4至-5.6 mL; P =. 009）。与Sham组相比，OSTAP阻滞可降低运动过程中各时间点的VAS评分。OSTAP组术后24小时恶心评分显著低于Sham组。结论：我们得出结论，双侧超声引导下OSTAP阻滞可减少腹腔镜子宫切除术后24小时曲马多需求量和VAS评分。OSTAP阻滞是一种有前途的技术，用于腹腔镜子宫切除术患者产生有效和持久的术后镇痛。
Background: We aimed to assess whether an ultrasound (US)-guided oblique subcostal transversus abdominis plane (OSTAP) block would improve the postoperative pain scores and decrease the tramadol consumption after a laparoscopic hysterectomy.Methods: Sixty-six female patients with American Society of Anesthesiologists I, II, or III, aged 18 to 65 years who were scheduled for laparoscopic hysterectomy for benign gynecologic pathologies were recruited in this randomized, controlled, observer-blinded trial. Sixty patients completed the study. Patients were randomized into 2 groups. In the OSTAP group, the patients received a bilateral OSTAP block with 40 mL of 0.375% bupivacaine and in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. All patients received tramadol patient-controlled analgesia for the first 24th hour. Patients in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. The primary outcome was the 24th hour tramadol consumption. The secondary outcomes included visual analog scale (VAS) scores during movement, the tramadol consumption at the 1st, 4th, and 12th postoperative hours, and nausea scores at the 24th hour postoperatively.Results: At all time points, tramadol consumption of the OSTAP group remained significantly lower when compared with Sham group. The OSTAP group showed a statistically significant reduction at the postoperative 24th hour tramadol consumption (mean difference 22mg, 95% confidence interval -38.4 to -5.6 mL; P =. 009). Compared with the Sham group, OSTAP block reduced the VAS scores at all time points during movement. Nausea scores at the 24th postoperative hour were significantly lower in the OSTAP group compared with the Sham groupConclusion: We concluded that bilateral US-guided OSTAP blocks reduced 24th hour tramadol requirements and VAS scores after laparoscopic hysterectomy. The OSTAP block is a promising technique for producing effective and prolonged postoperative analgesia in patients undergoing laparoscopic hysterectomy surgeries.