中文题目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.PDF

中文题目 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 英文题目 Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective Randomized Study 摘要译者 路凯 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: Abstract 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