结合直肠膜阻塞与横腹平面阻塞通过一个穿刺腹腔镜上腹部手术后止痛:一个随机对照的前性研究
Shan Yu1,2, Yaling Wen1, Jing Lin1
1Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
BMC anesthesiology
|February 9, 2024
概括
一种结合直肠块 (RSB) 和横腹平面块 (TAPB) 的新一穿孔技术有效地管理腹腔镜上腹部手术后的疼痛. 这种方法可以减少阿片类药物的使用,疼痛评分和出现动荡,促进更快的恢复.
科学领域:
- 麻醉学 麻醉学
- 区域麻醉地区麻醉
- 疼痛管理 疼痛管理
背景情况:
- 直肠外围封锁 (RSB) 和横向腹部平面封锁 (TAPB) 是针对腹部手术的既定止痛技术.
- 有限的研究存在于结合RSB和TAPB使用单一穿刺用于腹腔镜上腹部手术疼痛.
- 阿片类药物消耗和术后疼痛评分是评估腹部手术疼痛缓解的关键指标.
研究的目的:
- 为了评估一口刺技术的疗效,将RSB和TAPB结合起来,用于外科手术期间的疼痛控制.
- 在腹腔镜上腹部手术中,将这种新的技术与标准的TAPB和无区域阻塞进行比较.
- 评估对阿片类药物消费,疼痛评分和患者康复的影响.
主要方法:
- 一项随机对照试验,涉及58名接受腹腔镜上腹部手术的患者.
- 三组:对照组 (没有阻塞),TAP组 (双边肋下TAPB) 和RT组 (一针刺 RSB + TAPB).
- 用0.33%的罗皮瓦卡因进行超声波引导的阻塞;所有患者都接受了患者控制的静脉静脉止痛疗法 (PCIA).
主要成果:
- 一次刺穿的RSB + TAPB技术提供了有效的止痛,覆盖了手术切口部位.
- 在RT组中,在手术后4,8,12和24小时,在休息和咳期间观察到明显较低的视觉模拟尺度 (VAS) 疼痛评分.
- RT组在24小时和48小时后显著减少了sufentanil消耗和止痛压缩,以及出现动荡的发病率较低.
结论:
- 结合TAPB的RSB的一次穿刺技术为腹腔镜上腹部手术提供了有效的术后止痛.
- 这种方法显著减少了麻醉后护理单位 (PACU) 的出现动荡.
- 联合阻断促进了患者更早的康复和改善疼痛管理结果.
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