[1]白洁,孟玮,黄生辉.腹腔镜胆囊切除术后不同浓度罗哌卡因腹横肌平面阻滞镇痛效果的随机对照研究[J].第三军医大学学报,2017,39(07):696-700.
 Bai Jie,Meng Wei,Huang Shenghui.Analgesic efficiency of different dose ropivacaine on transversus abdominis plane block after laparoscopic cholecystectomy: a randomized control trial[J].J Third Mil Med Univ,2017,39(07):696-700.
点击复制

腹腔镜胆囊切除术后不同浓度罗哌卡因腹横肌平面阻滞镇痛效果的随机对照研究(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第07期
页码:
696-700
栏目:
临床医学
出版日期:
2017-04-15

文章信息/Info

Title:
Analgesic efficiency of different dose ropivacaine on transversus abdominis plane block after laparoscopic cholecystectomy: a randomized control trial
作者:
白洁孟玮黄生辉
兰州大学第二医院麻醉科;康县第一人民医院消毒供应室
Author(s):
Bai Jie Meng Wei Huang Shenghui

Department of Anesthesiology, Second Hospital of Lanzhou University, Lanzhou, Gansu Province, 730030; Disinfection and Supply Room, First People’s Hospital of Kang County, 746500, Kang County, Gansu Province, China

关键词:
腹横肌平面阻滞罗哌卡因腹腔镜胆囊切除术疼痛数字评分
Keywords:
transversus abdominis plane block ropicacaine laparoscopic cholecystectomy pain scale
分类号:
R614.4;R657.4;R971.2
文献标志码:
A
摘要:

目的      对比不同浓度的罗哌卡因腹横肌平面(transversus abdominis plane,TAP)阻滞用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者术后的镇痛效应、整体转归和不良反应。方法      选择兰州大学第二医院2015年11月至2016年5月择期行LC的60例患者,采用随机数字表法分为0.250%、0.375%浓度罗哌卡因组,每组30例。两组患者均接受全凭静脉麻醉和靶控输注(target controlled infusion,TCI)下诱导和术中维持。手术开始前,实施双侧超声引导的TAP阻滞;手术结束前给予舒芬太尼维持镇痛,转运至麻醉后恢复室和病房后,患者有疼痛主诉时给予帕瑞昔布钠和舒芬太尼镇痛。分别记录术后首次使用额外镇痛药的时间、围术期阿片类药物和帕瑞昔布钠使用总量、术后不同时段的疼痛数字评分(numeric rating scale,NRS)以及相关的不良反应。结果     LC术后两组接受不同浓度的罗哌卡因行TAP阻滞的患者术中瑞芬太尼使用量比较,差异有统计学意义(P<0.05),术后镇痛药用量、各时间点疼痛评分和相关的不良反应比较,差异没有统计学意义(P>0.05)。结论      低浓度罗哌卡因与高浓度相比镇痛效果相当,建议降低浓度以提高TAP阻滞的安全性。

Abstract:

Objective     To compare the analgestic efficacy on transversus abdominis plane (TAP) block, overall rehabilitation and relative adverse reactions of different doses of ropivacaine in patients after laparoscopic cholecystectomy (LC).  Methods     A total of 60 patients undergoing elective LC in our hospital from November 2015 to May 2016 were prospectively recruited in this study. They were randomly divided into 2 groups, and received 0.250% and 0.375% ropivacaine respectively for bilateral TAP block. Total intravenous anesthesia (TIVA) was adopted in all patients, and target controlled infusion (TCI) was carried out through the anesthetic induction and maintained intra-operatively. A skilled anesthesiologist performed the bilateral subcostal TAP block under ultrasound guidance before the surgical incision was made. After operation, all patients were given sulfentanil to maintain the pain relief. The patients complaining of pain, in the postanesthetic care unit and the surgical ward, were injected additional analgesic parocoxib and sulfentanil. Afterwards, the following results of all patients were recorded: the first time to receive the additional analgesic, total dose of opioids and parocoxib during the perioperative time, scores numeric rating scale (NRS) for pain at different intervals and relative adverse effects. Results      Significant difference was found in the dose of remifentanil between the patients receiving different doses of ropivacaine in the bilateral TAP block (P<0.05). But there were no differences in the total amounts of opioids and parocoxib, scores of NRS at different intervals and relative adverse effects between the 2 groups (P>0.05). Conclusion     Low dose ropivacaine exerts similar analgestic efficacy when compared with high dose, so it is recommended to improve its safety for TAP block.

参考文献/References:

[1]DeOliveira G S Jr, Fitzgerald P, Streicher L F, et al.Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery[J].Anesth Analg, 2012,115(2): 262-267.DOI:10.1213/ANE.0b013e318257a380
[2]De-Oliveira G S Jr,CastroAlves L J, Nader A,et al.Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a metaanalysis of randomized controlled trials[J].Anesth Analg, 2014,118(2): 454-463. DOI: 10.1213/ANE. 0000000000000066
 [3]Ure B M, Troidl H, Spangenberger W, et al. Pain after laparoscopic cholecystectomy. Intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events[J]. Surg Endosc, 1994, 8(2): 90-96.
[4]McDonnell J G, Curley G, Carney J, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial[J]. Anesth Analg, 2008, 106(1): 186-191. DOI: 10.1213/01.ane.0000290294. 64090.f3
[5]Koltzenaurg M. Neural mechanisms of cutaneous nociceptive pain. Clin J Pain, 2000, 16(3 Suppl): S131-138.
[6]De Oliveira G S Jr, Milad M P, Fitzgerald P, et al. Transversus abdominis plane infiltration and quality of recovery after laparoscopic hysterectomy: a randomized controlled trial[J]. Obstet Gynecol, 2011, 118(6): 1230-1237. DOI:10.1097/AOG.0b013e318236f67f
[7]Champaneria R, Shah L, Geoghegan J, et al. Analgesic effectiveness of transversus abdominis plane blocks after hysterectomy: a metaanalysis[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 166(1): 1-9. DOI:10.1016/j.ejogrb.2012.09.012
[8]Abdallah F W, Chan V W, Brull R. Transversus abdominis plane block: a systematic review[J]. Reg Anesth Pain Med, 2012, 37(2): 193-209. DOI:10.1097/AAP.0b013e3182429531
[9]Bhatia N, Arora S, Jyotsna W, et al. Comparison of posterior and subcostal approaches to ultrasoundguided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy[J]. J Clin Anesth, 2014, 26(4): 294-299. DOI:10.1016/j.jclinane.2013.11.023
[10]ElDawlatly A A, Turkistani A, Kettner S C, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy[J]. Br J Anaesth, 2009, 102(6): 763-767. DOI:10.1093/bja/aep067
[11]Shibata Y, Sato Y, Fujiwara Y, et al. Transversus abdominis plane block[J]. Anesth Analg, 2007, 105(3): 883. DOI:10.1213/01.ane.0000268541.83265.7d
[12]Niraj G, Kelkar A, Jeyapalan I, et al. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery[J]. Anaesthesia, 2011, 66(6): 465-471. DOI:10.1111/j.1365-2044.2011.06700.x
[13]Griffiths J D, Barron F A, Grant S, et al. Plasma ropivacaine concentrations after ultrasoundguided transversus abdominis plane block[J]. Br J Anaesth, 2010, 105(6): 853-856. DOI:10.1093/bja/aeq255
[14]Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use[J]. Indian J Anaesth, 2011, 55(2): 104-110. DOI:10.4103/0019-5049.79875
[15]田玉科,梅伟.超声定位神经阻滞图谱[M].北京:人民卫生出版社,2011:184-189.
Tian Y K, Mei W. Atlas of Ultrasound Guided Nerve Block[M]. People’s Medical Publishing House, 2011: 184-189.
[16]Abdul Jalil R M, Yahya N, Sulaiman O, et al. Comparing the effectiveness of ropivacaine 0.5% versus ropivacaine 0.2% for transabdominis plane block in providing postoperative analgesia after appendectomy[J]. Acta Anaesthesiol Taiwan, 2014, 52(2): 49-53. DOI:10.1016/j.aat.2014.05.007
[17]Griffiths J D, Le N V, Grant S, et al. Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section[J]. Br J Anaesth, 2013, 110(6): 996-1000. DOI:10.1093/bja/aet015
[18]Xiang Z, Yao T, Hao R,et al.Transversus abdominis plane block for postoperative analgesia after laparoscopic surgery: a systemic review and meta-analysis[J]. Int J Cin Exp Med,2014,7(9):2966-2975.
[19]Akkaya A, Yildiz I, Tekelioglu U Y, et al. Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial[J]. Eur Rev Med Pharmacol Sci, 2014, 18(5): 717-722. DOI:10.5455/gulhane.206518

相似文献/References:

[1]雷晓峰,唐延先.左旋布比卡因与罗哌卡因蛛网膜下腔阻滞的比较[J].第三军医大学学报,2006,28(21):2200.
[2]肖小华,刘颖菊,丁敏,等.甲磺酸罗哌卡因与盐酸罗哌卡因的生物等效性分析[J].第三军医大学学报,2006,28(19):1968.
[3]李剑.硬膜外芬太尼罗哌卡因合剂用于乳腺癌根治术中的临床效果[J].第三军医大学学报,2006,28(08):812.
[4]熊章荣,唐延先.多瑞吉联合罗哌卡因用于腹腔镜胆囊切除术后镇痛的临床研究[J].第三军医大学学报,2007,29(07):643.
 XIONG Zhang-rong,TANG Yan-xian.Pain control after laparoscopic cholecystectomy[J].J Third Mil Med Univ,2007,29(07):643.
[5]苗茜,戴丽,陈澜,等.不同浓度布比卡因、左旋布比卡因、罗哌卡因复合芬太尼进行剖宫产术后镇痛的临床观察[J].第三军医大学学报,2011,33(03):316.
[6]颜娅,向波.不同给药方式硬膜外分娩镇痛的临床观察[J].第三军医大学学报,2014,36(16):1767.
 [J].J Third Mil Med Univ,2014,36(07):1767.
[7]王秀琼,陶国才.0.2%罗哌卡因硬膜外分娩镇痛的临床观察[J].第三军医大学学报,2002,24(01):0.[doi:10.16016/j.1000-5404.2002.01.003 ]

更新日期/Last Update: 2017-04-10