Ultrasound－guided versus laparoscopic－guided subcostal transversus abdominis plane （TAP） block versus No TAP block in laparoscopic cholecystectomy； a randomized double－blind controlled trial．

腹腔镜胆囊切除术中超声引导与腹腔镜引导的肋下腹横肌平面 （TAP） 阻滞与无 TAP 阻滞；一项随机双盲对照试验

Background：

Transversus abdominis plane （TAP） block is an effective modality for the control of immediate postoperative pain． The present randomized trial aimed to assess the efficacy of ultrasound－guided subcostal TAP （USTAP） and laparoscopic subcostal TAP （LSTAP） block as compared to standard care without TAP block after laparoscopic cholecystectomy．

背景：腹横肌平面（TAP）阻滞是控制术后即刻疼痛的有效方式。本随机试验旨在评估超声引导下的肋下 TAP （USTAP） 和腹腔镜肋下 TAP （LSTAP） 阻滞与腹腔镜胆囊切除术后无 TAP 阻滞的标准治疗相比的疗效。

Methods：

This was a prospective， randomized， controlled trial on patients who underwent laparoscopic cholecystectomy． Patients were equally randomized to one of three groups： USTAP， LSTAP， and control group （no TAP block）． The main outcome measures were pain scores and analgesic consumption within the first 24 h postoperatively， postoperative nausea and vomiting （PONV）， time to ambulation， time to first flatus， and adverse effects of TAP block．

方法：这是一项针对接受腹腔镜胆囊切除术患者的前瞻性、随机、对照试验。患者被随机分配到三组：USTAP、LSTAP 和对照组（无 TAP 阻滞）。主要结果指标是术后首个24 小时内的疼痛评分和镇痛剂用量、术后恶心和呕吐 （PONV）、下床时间、首次排气时间和 TAP 阻滞的不良反应。

Results：

The trial included 110 patients （90％ females） with a mean age of 40．9 ± 11．7 years． Both USTAP and LSTAP block groups were associated with significantly lower pain scores at 2， 6， 12， and 24 h postoperatively， lower cumulative dose of paracetamol， less PONV， and shorter time to flatus than the control group． USTAP and LSTAP block were associated with similar pain scores at all time points， similar analgesic requirements， a similar incidence of PONV， and comparable time to first ambulation and time to first flatus． No adverse effects related to TAP block were recorded．

结果：该试验包括 110 名患者（90％ 为女性），平均年龄为 40．9 ± 11．7 岁。USTAP 和 LSTAP 阻滞组与对照组相比，术后 2、6、12 和 24 小时疼痛评分显着降低，扑热息痛累积剂量更低，PONV 更少，排气时间更短。USTAP 和 LSTAP 阻滞在所有时间点与相似的疼痛评分、相似的镇痛剂需求、相似的 PONV 发生率以及相似的第一次下床时间和第一次排气时间相关。没有记录到与 TAP 阻滞有关的不良反应。

Conclusions：

TAP block is a safe and effective method for pain control and improving recovery after laparoscopic cholecystectomy． Both USTAP and LSTAP blocks were equally effective in terms of pain relief， analgesic requirements， PONV， return of bowel function， and time to ambulation．

结论：TAP阻滞是一种安全有效的腹腔镜胆囊切除术后疼痛控制和促进康复的方法。USTAP 和 LSTAP 阻滞在缓解疼痛、镇痛需求、PONV、肠功能恢复和步行时间方面同样有效。

部分统计结果展示：

1． Pain scores and analgesic requirements．

Both USTAP and LSTAP block groups were associated with significantly lower pain scores at 2， 6， 12， and 24 h postoperatively as compared to the control group where no TAP was performed．

2． Operative details．

The control group was associated with a significantly shorter operation time than the USTAP and LSTAP block groups （56．4 ± 10．4 vs 59．5 ± 9．4 vs 63．5 ± 14．6 min， p ＝ 0．04）． Overall， there were no significant differences between the three groups in the use of diathermy for hemostasis and the use of lavage． No adverse effects related to TAP block or intra－ or postoperative complications were recorded．

More patients in the control group experienced PONV than patients who had USTAP or LSTAP block （47．4％ vs 27．8％ vs 19．4％， p ＝ 0．003）． The mean time to first flatus was significantly longer in the control group than in the TAP block groups， however， there was no significant difference between the three groups in regards to the mean time to first ambulation．

END