腹腔镜直肠癌手术高龄患者腹横肌平面（TAP）阻滞的最佳局麻药浓度
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Optimal concentration of the transversus abdominis plane block in enhanced recovery after surgery protocols for patients of advanced age undergoing laparoscopic rectal cancer surgery
背景与目的
腹横肌平面（TAP）阻滞可改善VAS评分，降低镇痛药物吗啡的用量，但高龄患者局部麻醉药中毒的风险较高。本研究旨在探讨一种最佳局麻药浓度，可安全用于手术后高龄患者的加强快速康复（ERAS），又不会影响镇痛效果。
方 法
本试验纳入120例年龄≥65岁的腹腔镜直肠癌手术患者，接受全身麻醉联合TAP阻滞，随机分为四组：全身麻醉+0.25％罗哌卡因（A组）、全身麻醉+0.50％罗哌卡因（B组）、全身麻醉+0.75％罗哌卡因（C组）、 D组仅全身麻醉，罗哌卡因用量40ml。在基线、切皮时、腹腔探查和气管拔管时测量血浆肾上腺素、皮质醇、白细胞介素6和肿瘤坏死因子α的表达。在基线、术后第1天和第3天测量CD4 +和CD4 + / CD8 +细胞的比例。
结 果
TAP阻滞减轻了应激反应并加速了肠功能恢复，且VAS评分和镇痛药物的需用量显著降低，但B组和C组之间无统计学意义。
结 论
TAP阻滞在腹腔镜直肠癌手术老年患者的ERAS中起重要作用，0.5％罗哌卡因即可降低局麻药中毒的风险，又能保证良好的镇痛效果。
原始文献摘要
Ping-Chen, Qing-Song Lin ，Xian-Zhong Lin；Optimal concentration of the transversus abdominis plane block in enhanced recovery after surgery protocols for patients of advanced age undergoing laparoscopic rectal cancer surgery；Journal of International Medical Research 0(0) 1–10 2018Article reuse guidelines:sagepub.com/journals-permissions；
DOI: 10.1177/0300060518790699 .
Objective: The transversus abdominis plane (TAP) block ameliorates visual analogue scale scores and decreases morphine requirements, but its role remains unclear. Patients of advanced age are susceptible to local anesthetic intoxication. We aimed to identify an optimal concentration that can be used in enhanced recovery after surgery (ERAS) without compromising analgesic efficacy.
Methods: In total, 120 patients aged _65 years undergoing laparoscopic rectal cancer surgery received general anesthesia combined with a TAP block using 0.25% ropivacaine (Group A), 0.50% ropivacaine (Group B), or 0.75% ropivacaine (Group C) in a 40-mL volume. Group D only received general anesthesia. Epinephrine, plasma cortisol, interleukin-6, and tumor necrosis factor-a were measured at baseline, skin incision, celiac exploration, and tracheal extubation. The proportions of CD4and CD4/CD8 cells were measured at baseline and postoperative days 1 and 3.
Results: The TAP block relieved the stress response and accelerated intestinal functional recovery as shown by significant reductions in VAS scores and anesthetic requirements. However, there was no significant difference between Groups B and C.
Conclusion: The TAP block plays an important role in ERAS in older patients undergoing laparoscopic rectal cancer surgery, and 0.5% ropivacaine is an optimal concentration that can reduce toxicity without undermining analgesia.
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