术后镇痛：超声引导神经阻滞的效果

本文由“小麻哥的日常"授权转载

摘要译文

超声引导下经软骨膜入路双侧改良胸腹神经阻滞（M-TAPA）在腹腔镜胆囊切除术患者中的应用：

一项随机双盲对照试验

背景：

改良的经软骨膜入路胸腹神经阻滞（M-TAPA）是一种新技术，通过仅对软骨膜表面的下侧实施局部麻醉，可有效对胸腹前壁和侧壁进行镇痛。

目的：

本研究的主要目的是研究腹腔镜胆囊切除术（LC）患者术前实施M-TAPA阻滞的术后镇痛效果。

方法：

本研究设计为双盲、随机、对照、前瞻性研究。

研究共纳入68名患者。

M-TAPA组在全麻诱导后进行双侧M-TAPA阻滞。

对照组没有实施阻滞。

记录术后疼痛评分、前24小时的镇痛药使用量、止吐药用量、镇静、术后恶心呕吐（PONV）和恢复质量-40（QoR-40）评分。

结果：

无论是在休息还是运动期间，M-TAPA组的疼痛评分均显著低于对照组（每个时间点的p<0.001）。

M-TAPA组前24小时消耗的曲马多总量[中位数100 mg，最小-最大（0-200）]低于对照组（P<0.001）。

M-TAPA组术后QoR-40评分中位数高于对照组（P<0.001）。在其他结果方面，两组之间没有差异。

结论：

LC手术后，超声引导下的M-TAPA阻滞可有效降低术后疼痛评分和曲马多消耗。

据观察，恢复质量也更高，因为QoR-40评分更高。

关键词：

镇痛；腹腔镜胆囊切除术；神经阻滞；

疼痛管理；术后疼痛；超声检查。

图1研究流程图

图2超声图

（A）腹部肌肉超声图

（B）阻塞前软骨膜区域超声图像

（C）阻塞针和软骨下部注射点的超声图。

Cc：肋软骨，EO：外斜肌，IO：内斜肌，TO：腹横肌，LA：局部麻醉

图3休息和运动时15分钟和24小时之间的NRS变化

（A）M-TAPA组和对照组在不同随访时间点的休息时NRS平均得分。

（B） M-TAPA组和对照组在不同随访时间点运动时的平均NRS评分。

M-TAPA：经软骨膜入路改良胸腹神经阻滞，

NRS：数值评分量表

原文摘要

Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy:

 a randomized double-blind controlled trial

Background:

Modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a new technique that provides effective analgesia of the anterior and lateral thoracoabdominal walls by administering local anesthesia only to the underside of the perichondral surface.

The primary purpose of the present study was to investigate the postoperative analgesic efficacy of M-TAPA block performed before surgery in patients undergoing laparoscopic cholecystectomy (LC).

Method:

The present study was designed as a double-blind, randomized, controlled, prospective study.

 A total of 68 patients were included in the study.

 In group M-TAPA, M-TAPA block was performed bilaterally after the induction of general anesthesia.

No block was performed on the group control.

 The postoperative pain scores, analgesic use in the first 24 h, antiemetic consumption, sedation, postoperative nausea and vomiting (PONV), and Quality of Recovery-40 (QoR-40) scores were recorded.

Results: 

Pain scores were significantly lower in group M-TAPA than in the group control, both during resting and motion at all times (p < 0.001 at each time point). The total amount of tramadol consumed in the first 24 h was lower in group M-TAPA [median 100 mg, min-max (0-200)] than in the group control (P < 0.001). Postoperative median QoR-40 scores were higher in group M-TAPA compared with the group control (P < 0.001). There were no differences between the groups in terms of other results.

Conclusion: 

After the LC surgery, ultrasound-guided M-TAPA block reduced postoperative pain scores and tramadol consumption effectively. It was observed that the quality of recovery was also higher because QoR-40 scores were higher.

Keywords: 

Analgesia; Laparoscopic cholecystectomy; Nerve block; Pain management; Postoperative pain; Ultrasonography.

Fig. 1 CONSORT diagram of the study

Fig. 2 Ultrasonographic view of process (A) Ultrasonographic view of the abdominal muscles (B) Ultrasound image of the perichondral area before blocking (C) Sonographic view of the block needle and injection point at the lower aspect of chondrium. Cc: costal cartilage, EO: external oblique muscle, IO: internal oblique muscle, TO: transversus abdominis muscle, LA: local anesthetic

Fig. 3 NRS change between the 15th minute and 24 h at rest and movement (A) Average NRS scores at rest, for Group M-TAPA and Group Control at various time points of follow-up. (B) Average NRS scores at motion, for Group M-TAPA and Group Control at various time points of follow-up. M-TAPA: modified-thoracoabdominal nerves block through a perichondrial approach, NRS: numerical rating scale

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