Pain control in laparoscopic surgery: a case–control study between transversus abdominis plane-block and trocar-site anesthesia
Pain control in laparoscopic surgery: a case–control study between transversus abdominis plane-block and trocar-site anesthesia
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腹腔镜手术中的疼痛控制：腹横肌平面阻滞与套管针麻醉的病例对照研究
DOI：
10.1007/s13304-018-00615-y
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发表时间：
2018
影响因子：
2.6
通讯作者：
N. Vettoretto
中科院分区：
文献类型：
--
作者：
S. Molfino;E. Botteri;P. Baggi;L. Totaro;M. Huscher;G. Baiocchi;N. Portolani;N. Vettoretto
局部麻醉在腹腔镜手术中的应用越来越得到共识。为了标准化止痛，我们与我们社区医院的麻醉学服务合作，在一年的时间里创建了一项前瞻性病例对照研究。从2016年2月开始，我们前瞻性地招募了16岁以上的成人患者，在急诊或择期情况下接受腹腔镜阑尾切除术或胆囊切除术。患者在术前被分配(根据图表入院编号)接受腹横切面(TAP)阻断治疗(组1-实验臂)或套管针-部位麻醉(TSA)组(组2-实验臂)，然后与未接受治疗的患者组(组3-控制组)进行比较。记录每个患者的人口学和临床特征。术后疼痛程度(主要结果)通过视觉模拟评分(VAS)进行评估；止痛药的使用和住院时间被定义为次要结果。42例患者接受TAP封闭治疗(第1组)，52例患者接受TSA治疗(第2组)，39例患者未接受术前治疗(第3组)。在接受TAP或TSA的患者与对照组的比较中，报告的疼痛在每个预定时间都有显著差异(p<； 在苏醒后0、6、12、18、24和48h有显著差异)。就主要结果而言，两个局部麻醉组都有好处。在所有接受腹腔镜胆囊切除和阑尾切除术的患者中，术前TSA的使用可以成为一种常规做法，以减少择期和急诊手术后的疼痛。
Local anesthesia in laparoscopic operations is gaining increasing consensus. To standardize analgesia, a prospective case–control study was created over a 1-year period, in collaboration with the anesthesiology service in our community hospital. Starting from February 2016, we prospectively enrolled adult patients (more than 16 years old) undergoing laparoscopic appendectomy or cholecystectomy, either in emergency or elective setting. Patients were preoperatively assigned (based on the chart-admission number) either to transversus abdominis plane (TAP) block treatment (Group 1—experimental arm) or trocar-site anesthesia (TSA) (Group 2—experimental arm), and then compared with group of patients not submitted to treatment (Group 3—control arm). Demographic and clinical characteristics of each patient were recorded. Post-operative pain level (primary outcome) was assessed with visual analog scale (VAS) score; analgesic use and length of stay in hospital were defined as secondary outcomes. Forty-two patients were assigned to TAP block treatment (Group 1), fifty-two to TSA (Group 2), and thirty-nine underwent no pre-incisional treatment (Group 3). In the comparison between patients undergoing TAP block or TSA with the control arm, a significance difference in reported pain was recorded in every scheduled time (p< 0.05 at 0, 6, 12, 18, 24, and 48 h from awakening). Both local anesthesia groups share a benefit in terms of primary outcome. The use of pre-incisional TSA for all the patients undergoing laparoscopic cholecystectomy and appendectomy could become a routine practice to reduce post-operative pain both in the elective and emergency setting.