Analgesia and respiratory function after laparoscopic cholecystectomy in patients receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a randomized double-blind study.
Analgesia and respiratory function after laparoscopic cholecystectomy in patients receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a randomized double-blind study.
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DOI：
10.12659/msm.893593
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发表时间：
2015-05-07
期刊：
影响因子：
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通讯作者：
Ozmen S
中科院分区：
文献类型：
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作者：
Basaran B;Basaran A;Kozanhan B;Kasdogan E;Eryilmaz MA;Ozmen S
腹横肌平面 (TAP) 阻滞已被证明可以减轻腹部手术后的术后疼痛。术后疼痛相关的呼吸系统损害已成为多项研究的主题。在此，我们评估斜肋下 TAP (OSTAP) 阻滞对术后前 24 小时内疼痛和呼吸功能的影响。在这项双盲、随机研究中，76 名接受腹腔镜胆囊切除术的患者被分配到 OSTAP 组 (n=38) 或对照组 (n=38)。全身麻醉诱导后，用 20 ml 0.25% 布比卡因进行双侧超声引导 OSTAP 阻滞。 OSTAP 组和对照组均根据术后镇痛需要使用扑热息痛、替诺昔康和曲马多进行治疗。在前 24 小时内评估视觉模拟量表 (VAS) 疼痛评分（移动时和休息时）、第一秒用力呼气量 (FEV1)、用力肺活量 (FVC)、峰值呼气流速 (PEFR)、动脉血气变量和阿片类药物消耗量。 OSTAP 组在到达 PACU 时和术后 2 小时时，休息时和移动时的 VAS 疼痛评分显着较低。 OSTAP 组术后 0-2 小时和 2-24 小时的曲马多总需求量显着减少。与对照组相比，OSTAP 组术后 FEV1 和 FVC 恶化明显较少（分别为 P<0.01 和 P<0.05）。动脉血气变量没有组间差异。腹腔镜胆囊切除术后，OSTAP 阻滞可以显着改善呼吸功能并更好地缓解疼痛，同时降低阿片类药物的需求。
Transversus abdominis plane (TAP) block has been shown to ameliorate postoperative pain after abdominal surgery. Postoperative pain-associated respiratory compromise has been the subject of several studies. Herein, we evaluate the effect of oblique subcostal TAP (OSTAP) block on postoperative pain and respiratory functions during the first 24 postoperative hours. In this double-blind, randomized study, 76 patients undergoing laparoscopic cholecystectomy were assigned to either the OSTAP group (n=38) or control group (n=38). Bilateral ultrasound-guided OSTAP blocks were performed with 20 ml 0.25% bupivacaine after induction of general anesthesia. Both the OSTAP and control groups were treated with paracetamol, tenoxicam, and tramadol as required for postoperative analgesia. Visual Analog Scale (VAS) pain scores (while moving and at rest), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), arterial blood gas variables, and opioid consumption were assessed during first 24 h. VAS pain scores at rest and while moving were significantly lower in the OSTAP group on arrival to PACU and at 2 h postoperatively. The total postoperative tramadol requirement was significantly reduced at 0–2 h and 2–24 h in the OSTAP group. Postoperative deterioration in FEV1 and FVC was significantly less in the OSTAP group when compared to the control group (P<0.01 and P<0.05, respectively). There were no between-group differences in arterial blood gas variables. After laparoscopic cholecystectomy, OSTAP block can provide significant improvement in respiratory function and better pain relief with lower opioid requirement.