在下腹部手术患者术后镇痛中腹横肌平面镇痛与硬膜外镇痛的比较：一项前瞻性随机研究
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Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective
Randomized Study
背景与目的
麻醉医生在术后疼痛管理中发挥重要作用。下腹部手术术后镇痛中，硬膜外镇痛和超声引导下腹横肌平面（TAP）阻滞是合适的选择。本研究旨在比较这两种技术的镇痛效果。
方 法
七十二例腰麻下行下腹部手术患者随机分为术后接受硬膜外置管组（E组）或超声引导下通过双侧放置静脉导管行TAP阻滞组（T组）。E组给予0.125%布比卡因，10毫升/每8小时，持续48小时。t组给予0.125%布比卡因，20毫升/每8小时，持续48小时。记录在休息和咳嗽时的疼痛，以及扑热息痛和曲马多总用量。
结 果
在第一个16小时，休息时的镇痛效果两组相当，在24和48 h时，E组在休息时有明显的镇痛作用（P分别为0.001和0.004）。E组患者中，咳嗽时无痛或有轻度疼痛的患者数量明显高，对乙酰氨基酚的用量在两组相当，但在最后曲马多用量T组明显高（P = 0.001）。
结 论
对下腹部手术，前16 h在硬膜外置管组和腹横肌平面TAP阻滞组中0.125%的布比卡因给予的镇痛效果两组相当，然而，除了两组在休息和咳嗽时均减少阿片类药物的用量之外，硬膜外导管所提供的镇痛效果优于腹横肌平面TAP阻滞。
原始文献摘要
Sadasivan Shankar Iyer, Harshit Bavishi 1 , Chadalavada Venkataram Mohan et al.Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective Randomized Study
Background:
Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques.
Materials and Methods:
Seventy-two patients undergoing lower abdominal surgery
under spinal anesthesia were randomized to postoperatively
receive lumbar epidural catheter (Group E) or ultrasound-
guided TAP block (Group T) through intravenous cannulas
placed bilaterally. Group E received 10 ml 0.125% bupivacaine
stat and 10 ml 8 th hourly for 48 h. Group T received 20 ml
0.125% bupivacaine bilaterally stat and 20 ml bilaterally 8 th
hourly for 48 h. Pain at rest and on coughing, total paracetamol and tramadol consumption were recorded.
Results:
Analgesia at rest was comparable between the groups in the
first 16 h. At 24 and 48 h, Group E had significantly better
analgesia at rest (P = 0.001 and 0.004 respectively). Patients in
Group E had significantly higher number of patients with nil or
mild pain on coughing at all times. Paracetamol consumption
was comparable in both groups, but tramadol consumption was significantly higher in Group T at the end of 48 h (P = 0.001).
Conclusion:
For lower abdominal surgeries, analgesia provided by
intermittent boluses of 0.125% is comparable for first 16 h
between epidural and TAP catheters. However, the quality of
analgesia provided by the epidural catheter is superior to that
provided by TAP catheters beyond that both at rest and on
coughing with reduced opioid consumption.
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