Bilateral subcostal transversus abdominis plane block does not improve the postoperative analgesia provided by multimodal analgesia after laparoscopic cholecystectomy A randomised placebo-controlled trial
Bilateral subcostal transversus abdominis plane block does not improve the postoperative analgesia provided by multimodal analgesia after laparoscopic cholecystectomy A randomised placebo-controlled trial
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DOI：
10.1097/eja.0000000000001028
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发表时间：
2019-10-01
影响因子：
3.6
通讯作者：
Joris, Jean L.
中科院分区：
文献类型：
--
作者：
Houben, Alan M.;Moreau, Anne-Sophie J.;Joris, Jean L.
背景腹腔镜胆囊切除术可能被认为是小手术，但它可能会导致严重的术后疼痛。肋下腹横肌平面（TAP）阻滞可产生持久的脐上顶叶镇痛，可能会改善腹腔镜胆囊切除术后的镇痛效果。目的：我们研究肋下TAP阻滞是否能减少腹腔镜胆囊切除术后多模式镇痛患者的阿片类药物消耗和疼痛。设计：随机、安慰剂对照、双盲研究。研究地点：2017年12月至2018年6月在一所大学教学医院进行。60例拟行腹腔镜胆囊切除术的患者纳入研究。麻醉和术后镇痛（依托考昔、扑热息痛、氯胺酮和地塞米松）标准化。干预麻醉诱导后，患者被分为两组：超声引导下双侧肋下TAP阻滞20 ml的左旋布比卡因0.375%和肾上腺素5 μ g ml（-1）或0.9%生理盐水肾上腺素5 μ g ml（-1）。主要观察指标：记录恢复室和术后24 h内阿片类药物的消耗量。测量术后躯体和内脏疼痛评分、疲劳和恶心。还记录了七氟烷（FETSEVO）的术中潮气末浓度。结果两组术后24小时阿片类药物消耗量相似：左布比卡因组和0.9%生理盐水组分别为21.2 mg（95% CI 15.3 - 27.1）vs. 25.2（95% CI 15.1 - 35.5）口服吗啡当量; P = 0.48。在顶骨（P = 0.56）和内脏（P = 0.50）疼痛评分、疲乏和恶心方面未观察到显著的组间差异。左布比卡因组的FETSEVO略低（P < 0.01）。结论肋下TAP阻滞不能改善腹腔镜胆囊切除术后多模式镇痛的效果。它允许术中七氟烷需求的小幅减少。
BACKGROUND Laparoscopic cholecystectomy might be considered minor surgery, but it may result in severe postoperative pain. Subcostal transversus abdominis plane (TAP) block, which produces long-lasting supra-umbilical parietal analgesia, might improve analgesia after laparoscopic cholecystectomy. OBJECTIVE We investigated whether subcostal TAP block would reduce opioid consumption and pain after laparoscopic cholecystectomy in patients provided with multimodal analgesia. DESIGN A randomised, placebo-controlled, double-blind study. SETTING The study was conducted at a university teaching hospital from December 2017 to June 2018. PATIENTS Sixty patients scheduled for laparoscopic cholecystectomy were included. Anaesthesia and postoperative analgesia (etoricoxib, paracetamol, ketamine and dexamethasone) were standardised. INTERVENTION After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral subcostal TAP block with 20 ml of levobupivacaine 0.375% and epinephrine 5 mu g ml(-1) or 0.9% saline with epinephrine 5 mu g ml(-1). MAIN OUTCOME MEASURES Opioid consumption in the recovery room and during the first 24 h after surgery were recorded. Postoperative somatic and visceral pain scores, fatigue and nausea were measured. Intra-operative end-tidal concentrations of sevoflurane (FETSEVO) were also recorded. RESULTS Twenty-four hour postoperative opioid consumption were similar in both groups: 21.2 mg (95% CI 15.3 to 27.1) vs. 25.2 (95% CI 15.1 to 35.5) oral morphine equivalent in the levobupivacaine and 0.9% saline groups, respectively; P = 0.48. No significant between-group differences were observed with regards to parietal (P = 0.56) and visceral (P = 0.50) pain scores, fatigue and nausea. FETSEVO was slightly lower in the levobupivacaine group (P < 0.01). CONCLUSION Subcostal TAP block does not improve the analgesia provided by multimodal analgesia after laparoscopic cholecystectomy. It allows for a small reduction in intra-operative sevoflurane requirements.