Effect of ultrasound-guided peripheral nerve blocks of the abdominal wall on pain relief after laparoscopic cholecystectomy
Effect of ultrasound-guided peripheral nerve blocks of the abdominal wall on pain relief after laparoscopic cholecystectomy
复制标题
超声引导下腹壁周围神经阻滞对腹腔镜胆囊切除术后疼痛缓解的影响
DOI：
10.2147/jpr.s203721
复制
发表时间：
2019
影响因子：
2.7
通讯作者：
Junma Yu
中科院分区：
文献类型：
--
作者：
Lining Wu;Liangchun Wu;Hao Sun;C. Dong;Junma Yu
目的：这项研究的目的是比较超声引导的横向腹部平面块（TAPB）和直肌鞘块（RSB）组合的效果，这是超声引导后的后锥块，结合了局部麻醉剂（LAI）和单独使用腹腔镜胆囊切除术（LC）的疼痛缓解（LC）。 LC港口分为3组。如果视觉模拟量表（VAS）得分（包括切口疼痛，内脏疼痛或肩部疼痛）在第一，第四，第8，24和48小时内评估后疼痛。慢慢地注射睡眠质量，脱氧粉的总消费量，并记录了镇痛的全球满意度评分（GSS）。或对脱氧剂的要求：超声引导的腹壁周围神经阻滞可显着缓解接受LC的患者的术后疼痛；但是，接受LAI的患者表达了比使用其他方法的患者更满意的。未转换为开放手术的LC患者的常规临床实践。
Purpose: The aim of this study was to compare the effect of an ultrasound-guided transversus abdominis plane block (TAPB) and rectus sheath block (RSB) combination, an ultrasound-guided posterior TAP block combined with the local anesthetic infiltration (LAI) and LAI alone on pain relief after laparoscopic cholecystectomy (LC). Patients and methods: One hundred eighty patients who were American Society of Anesthesiologists class Ι or Π were included in this randomized, double-blind, non-inferiority study. All patients underwent three-port LC and were divided into 3 groups. The LAI group had ropivacaine mixed with dexmedetomidine injected around the trocar entrance site preoperatively. The TL group underwent ultrasound-guided posterior TAPB combined with LAI, and the TR group underwent ultrasound-guided TAPB combined with RSB. Postoperative pain was evaluated at the first, 4th, 8th, 24th, and 48th hours. If the visual analogue scale (VAS) score (including incisional pain, visceral pain or shoulder pain) was >3, intravenous dezocine (0.05 mg/kg) was injected slowly. Sleep quality, total consumption of dezocine and time to unassisted walking were recorded. The Global Satisfaction Score (GSS) for analgesia was also assessed within 48 hrs. Results: No difference was found in sleep quality, time to unassisted walking, or requirement for dezocine. We also found no difference in VAS scores at each time point within 48 hrs after LC among the 3 groups, but the GSS for analgesia in the LAI group was significantly increased within 48 hrs compared with the other two groups. Conclusion: Ultrasound-guided peripheral nerve blocks of the abdominal wall can significantly relieve postoperative pain in patients undergoing LC; however, patients receiving LAI expressed more satisfaction than patients in whom other methods were used. LAI is an easy and effective method that can be recommended for routine clinical practice in LC patients who are not converted to an open procedure.