超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞在妇科腹腔镜手术中的应用

Abstract
Figure/Table
References
Related Citation (15)

Download: PDF (2299 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To explore the application of ultrasound-guided transversal abdominis plane block (TAPB) combined with rectus sheath block (RSB) during gynecological laparoscopic surgery. Methods 80 patients with gynecological laparoscopic surgery who received treatment in Anqing First People’s Hospital of Anhui Medical University from March 2021 to March 2023 were included and randomly divided into single group and combined group with 40 cases in each group. The single group received total intravenous anesthesia, and the combined group was given total intravenous anesthesia + TAPB combined with RSB anesthesia. Surgical indicators were compared between the two groups, and the hemodynamics [heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO₂) ] before anesthesia (T0), immediately after skin resection (T1) and at the end of surgery (T2). stress response indicators [C-reactive protein (CRP), interleukin-6(IL-6), tumor necrosis factor-α (TNF-α) ] at T0 and at 12 hours after surgery and analgesic effect [Visual Analogue Scale (VAS) ] at 4, 8 and 12 hours after surgery were compared between the two groups of patients. Results The spontaneous breathing time, first ambulation time and first exhaust time in combined group were shorter than those in single group. HR at T0-T2 in both groups was increased first and then decreased, and HR at T1 in combined group was lower than that in single group, and MAP was decreased first and then increased, and MAP in combined group at T1 was higher than that in single group. The levels of CRP, IL-6 and TNF-α in the two groups at 12 hours after surgery were enhanced compared with those at T0, but the levels in combined group were lower than those in single group. VAS score in combined group was lower than that in single group at 4, 8 and 12 hours after surgery. Conclusion TAPB combined with RSB has a good analgesic effect during gynecological laparoscopic surgery, and can stabilize the hemodynamics and relieve the stress response and postoperative pain.

Key words： gynecological laparoscopic surgery transversal abdominis plane block rectus sheath block ultrasound hemodynamics analgesic effect

Received: 12 March 2024

PACS:

R713

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	HE Jia
	WU Niansheng
	WANG Dongxue
	WANG Hui
	ZHANG Yuedong

Cite this article:

HE Jia,WU Niansheng,WANG Dongxue等. Application of ultrasound-guided transversal abdominis plane block combined with rectus sheath block during gynecological laparoscopic surgery[J]. HuNan ShiFan DaXue XueBao(YiXueBan), 2024, 21(3): 82-85.

URL:

http://yxb.hunnu.edu.cn/EN/ OR http://yxb.hunnu.edu.cn/EN/Y2024/V21/I3/82

[1] 于显博, 李程程, 朱萍, 等. 宫腹腔镜联合手术治疗Ⅱ、Ⅲ型子宫瘢痕妊娠的疗效分析[J]. 中南医学科学杂志, 2022, 50(5): 713-715.
[2] 庞刚, 周俨, 李军, 等. 腹横肌平面阻滞术联合右美托咪定对妇科腹腔镜手术患者苏醒质量和应激指标的影响[J]. 中国药业, 2020, 29(18): 85-88.
[3] 丁玉兰, 王文娟, 张艳. 腹腔镜与开腹对行全子宫切除术患者手术学指标、应激反应、预后的影响对比研究[J]. 湖南师范大学学报 (医学版), 2021, 18(1): 154-158.
[4] VARSHNEY A, PRABHU M, PERIYADKA B, et al.Transversus abdominis plane (TAP) block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia following cesarean delivery[J]. J Anaesthesiol Clin Pharmacol, 2019, 35(2): 161-164.
[5] 王卫华, 杨红军, 王尚柯, 等. 超声引导下腹横肌平面阻滞与腰方肌阻滞在腹腔镜子宫肌瘤剔除术中的应用效果比较[J]. 新乡医学院学报, 2022, 39(2): 182-186.
[6] XU L, HU Z, SHEN J, et al.Efficacy of US-guided transversus abdominis plane block and rectus sheath block with ropivacaine and dexmedetomidine in elderly high-risk patients[J]. Minerva Anestesiol, 2018, 84(1): 18-24.
[7] 林祺. 超声引导双侧腹直肌鞘阻滞在行日间单孔腹腔镜卵巢囊肿剥除术患者中的镇痛效果评价[J]. 山西医药杂志, 2022, 51(19): 2235-2238.
[8] 宗行万之助. 疼痛的估价—用特殊的视觉模拟评分法作参考 (VAS)[J]. 疼痛学杂志, 1994, 2(4): 153-154.
[9] 王赟, 张萍, 何香梅, 等. 超声引导下腹横肌平面阻滞在腹腔镜妇科手术后镇痛中的应用[J]. 解放军医学院学报, 2019, 40(11): 1030-1033.
[10] 王璇, 田蜜, 王敏, 等. 超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞在腹腔镜子宫切除术的应用[J]. 中国医师进修杂志, 2021, 44(9): 805-809.
[11] KARAMAN T, OZSOY AZ, KARAMAN S, et al.The effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy: a randomized controlled study[J]. Braz J Anesthesiol, 2018, 68(3): 285-291.
[12] ST JAMES M, FERREIRA TH, SCHROEDER CA, et al.Ultrasound-guided rectus sheath block: an anatomic study in dog cadavers[J]. Vet Anaesth Analg, 2020, 47(1): 95-102.
[13] 于洋, 许军, 杨胜男, 等. 超声引导下TAP阻滞对妇科腹腔镜手术麻醉效果和术后镇痛的影响[J]. 武警后勤学院学报 (医学版), 2021, 30(09): 181-182.
[14] 党璐, 常宝生, 高洁, 等. 超声引导下腹横肌平面阻滞在妇科腹腔镜三、四级手术患者术后镇痛中的应用[J]. 中国医师杂志, 2020, 22(3): 423-425.
[15] 汪文娟, 吴向荣, 黄昌云. 超声引导下的双侧TAP阻滞对上腹部手术患者血流动力学、炎症反应及术后镇痛的影响[J]. 中国医药导报, 2021, 18(16): 104-108.
[16] 李玲, 黄源, 刘松华, 等. 不同时点超声引导腹横肌平面阻滞在开放性全子宫切除术中的效果比较[J]. 中国医师杂志, 2019, 21(6): 814-817.
[17] 刘明红, 于乐涛, 石军. 腹直肌鞘阻滞用于剖宫产术后镇痛效果观察及对产后抑郁发生的影响[J]. 蚌埠医学院学报, 2020, 45(8): 1072-1076.
[18] HAUSKEN J, RYDENFELT K, HORNELAND R, et al.First experience with rectus sheath block for postoperative analgesia after pancreas transplant: a retrospective observational study[J]. Transplant Proc, 2019, 51(2): 479-484.
[19] 胡松权, 宋劼, 周群. 超声引导腹横肌平面阻滞联合腹直肌鞘阻滞在腹腔镜全子宫切除术患者中的应激状况及术后镇痛效果[J]. 中国妇幼保健, 2022, 37(6): 1140-1143.