经腹平面阻滞作为多模式镇痛的一部分减少全腹子宫切除术患者阿片类药物消耗的有效性:一项随机对照试验

Journal of the Bangladesh Society of Anaesthesiologists Pub Date : 2020-01-31 DOI:10.3329/jbsa.v33i1.67477

Md Ali Haider, Rabeya Begum, Md. Sirajul Islam, M. N. Islam, Subrata Mondal, Md Gishan Hossain, Md Jahid Iqbal

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引用次数: 0

摘要

背景:腹式全子宫切除术后，患者普遍存在中度至重度的术后疼痛。多模式方法被用来减少这种痛苦。目的:本研究的目的是观察经腹平面阻滞作为多模式镇痛的一部分对减少全子宫切除术患者阿片类药物消耗的有效性。方法:本随机对照试验于2016年3月至2018年9月在孟加拉国达卡达卡医学院和医院麻醉、镇痛、姑息和重症监护医学系进行，为期两年零六个月。计划在全身麻醉下行选择性腹式全子宫切除术的妇女被选为研究人群。参与者被随机分为两组，分别是第一组和第二组。两组患者均给予全身麻醉。ⅰ组患者给予0.25%布比卡因20 ml，ⅱ组患者给予生理盐水20 ml作为安慰剂。然后穿衣就完成了。在第12肋(肋缘)和髂骨之间触诊的侧翼采取所有无菌预防措施后进行TAP阻滞。确认体位正确后，ⅰ组患者给予0.25%布比卡因20 ml，ⅱ组患者给予经超声确认的筋膜层生理盐水20 ml。结果:本研究共招募了40例患者，平均分为两组。其中I组20例，II组20例。I组患者平均年龄53.08±4.25岁，II组患者平均年龄51.5±4.97岁(p= 0.286)。本研究中，I组有5例(25.0%)恶心，II组有8例(40.0%)，I组有3例(15%)呕吐，II组有4例(20.0%)呕吐(p>0.05)。第一组平均首次镇痛时间为8.39±1.85 h，第二组平均首次镇痛时间为1.59±0.21 h (p=0.001)。平均吗啡总用量I组为14.78±3.56,II组为26.30±5.9 (p<0.05)。结论:TAP阻断可有效降低术后吗啡总消耗量。JBSA 2020;33 (1): 16

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Effectiveness of Transversus Abdominis Plane Block as part of a Multimodal Analgesia to Reduce Opioid Consumption among Total Abdominal Hysterectomy Patients: A Randomized Control Trial

Background:Generally patients after total abdominal hysterectomy have suffered from moderate tosevere postoperative pain. Multimodal approach are using to reduce this pain. Objective:The purpose of the present study was to observe the effectiveness of transversus abdominisplane block as part of amultimodal analgesia to reduce opioid consumption among total hysterectomypatients. Methodology:This randomized control trial was conducted in Department of Anaesthesia, Analgesia,Palliative and Intensive Care Medicine of Dhaka Medical College and Hospital, Dhaka, Bangladeshfrom March 2016 to September 2018 for a period two years and six months. Women planned for anelective total abdominal hysterectomy under general anesthesia were selected as study population.Participants were selected and randomly divided into two groups designed as group I and group II.Patient of both group were given general anesthesia. Group I patient received 20 ml 0.25% bupivacaineand group II patient received 20 ml normal saline as placebo. Then dressing was done. The TAP blockwas performed after taking all aseptic precaution in the flank palpated between the 12th rib (Costalmargin) and the iliac crest. After confirmation of correct position, 20 ml 0.25% bupivacaine was given togroup I patient and 20 ml normal saline was given to group II patient within the fascial layer whichwas confirmed by ultrasound. Result:A total number of 40 patients were recruited for this study and were equally divided into twogroups. Thus 20 patients were in the group I and the rest 20 patients were in group II. The mean age ofgroup I were 53.08 ±4.25 and group II were 51.5±4.97 (p= 0.286).In this study 5(25.0%) patients hadnausea in group I and 8(40.0%) in group II, 3(15%) patients had vomiting in group I and 4(20.0%) ingroup II (p>0.05). The mean first analgesic demand was 8.39±1.85 hours in group I and 1.59±0.21 hoursin Group II (p=0.001).The mean total morphine consumption was 14.78±3.56 in group I and 26.30±5.9in group II (p<0.05). Conclusion:TAP block effectively reduced the total postoperative morphine consumption. JBSA 2020; 33(1): 16-21

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Journal of the Bangladesh Society of Anaesthesiologists

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