Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel "4-point' techniqueresults of a prospective, randomized study
Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel "4-point' techniqueresults of a prospective, randomized study
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DOI：
10.1007/s11701-018-0858-6
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发表时间：
2019-02-01
影响因子：
2.3
通讯作者：
Zattoni, Fabio
中科院分区：
文献类型：
--
作者：
Dal Moro, Fabrizio;Aiello, Luca;Zattoni, Fabio
一些著作强调了超声引导下腹横肌平面阻滞（TAPb）对于术后镇痛的重要性及其在剖腹手术和腹腔镜手术中在所有类型腹部手术中的多功能性。本研究的目的是评估机器人辅助根治性前列腺切除术 (RARP) 后 24 小时内 TAPb 对术中和术后镇痛的影响。 TAPb 是一种新的局部麻醉技术，可在腹部手术后提供镇痛。它涉及将局部麻醉剂注射到腹横肌和内斜肌之间的平面。 TAPb 可以根据标志性技术通过腰三角或超声引导进行。我们评估了 100 名 ASA I-III 患者在术后 24 小时内在不使用（A 组，50 名患者）或使用 US-TAPb（B 组，50 名患者）全身麻醉下接受 RARP 的术中和术后镇痛效果。全身麻醉诱导后，对 50 名选定的患者进行了 US-TAPb。所有患者均接受术后镇痛（扑热息痛1g），每日3次。如果数值评定量表测试 >3，则使用曲马多和酮洛芬作为救援药物。块执行期间没有记录到并发症。接受 US-TAPb 的患者术中使用阿片类药物的需要以及术后疼痛或术后药物消耗的发生率显着减少。 A 组中有 7 名患者接受 100 毫克曲马多治疗。 B 组中，只有一名患者因手术并发症而接受了 100 毫克曲马多（术后第一天和第二天）。总之，US-TAPb 在 RARP 后的前 24 小时内提供了高效的术中和术后镇痛。有必要进行进一步的前瞻性研究来评估适合所有患者的最佳方案。
Several works stress the importance of ultrasound-guided transversus abdominis plane block (TAPb) for post-operative analgesia and its versatility in all types of abdominal surgery, thanks to laparotomy and laparoscopy. The aim of this study was to evaluate the impact of TAPb on intra- and post-operative analgesia in the first 24h after robot-assisted radical prostatectomy (RARP). TAPb is a new local anesthetic technique which provides analgesia after abdominal surgery. It involves injection of local anesthetic into the plane between the transversus abdominis and the internal oblique muscles. TAPb can be performed according to a landmark technique, either through the lumbar triangle or with ultrasound guidance. We evaluated the intra- and post-operative analgesic efficacy of TAPb in 100 ASA I-III patients undergoing RARP under general anesthesia without (group A, 50 patients) or with US-TAPb (group B, 50 patients), in the first 24 post-operative hours. After induction of general anesthesia, US-TAPb was performed in 50 selected patients. All patients received post-operative analgesia (Paracetamol 1g) three times a day. Tramadol and Ketoprofen were used as rescue drugs if the Numerical Rating Scale test was >3. No complications were recorded during block performance. A significant reduction was seen in the need to administer intraoperative opioids, and in the occurrence of post-operative pain or post-operative drug consumption in patients receiving US-TAPb. Seven patients, all in group A, received 100mg of Tramadol. In group B, only one patient received 100mg Tramadol (first and second post-operative days) due to surgical complications. In conclusion, US-TAPb provided highly effective intra- and post-operative analgesia in the first 24h after RARP. A further prospective study is necessary to assess the best protocol for all patients.