The Analgesic Efficacy of Subcostal Transversus Abdominis Plane Block Compared with Thoracic Epidural Analgesia and Intravenous Opioid Analgesia After Radical Gastrectomy

被引:102
作者
Wu, Yiquan [1 ]
Liu, Fuli [1 ]
Tang, Hongli [1 ]
Wang, Quanguang [1 ]
Chen, Limei [1 ]
Wu, Hui [1 ]
Zhang, Xuezheng [1 ]
Miao, Jianxia [1 ]
Zhu, Meizhen [1 ]
Hu, Chenggang [2 ]
Goldsworthy, Mark [3 ]
You, Jing [4 ,5 ]
Xu, Xuzhong [1 ]
机构
[1] Wenzhou Med Coll, Affiliated Hosp 1, Dept Anesthesiol, Wenzhou City 325000, Zhejiang, Peoples R China
[2] Pomerado Hosp, Dept Anesthesiol, Poway, CA USA
[3] Palomar Med Ctr, Dept Anesthesiol, Escondido, CA USA
[4] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA
[5] Cleveland Clin, Dept Outcomes Res, Cleveland, OH 44106 USA
关键词
POSTOPERATIVE PAIN;
D O I
10.1213/ANE.0b013e318297fcee
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: The transversus abdominis plane (TAP) block has been shown to provide effective postoperative analgesia in lower abdominal surgery. Subcostal TAP block has also been proposed as a new technique to provide analgesia for the supraumbilical abdomen. We compared the analgesic and opioid-sparing effects of a single-injection subcostal TAP block with continuous thoracic epidural analgesia and IV opioid analgesia. METHODS: Ninety patients undergoing elective radical gastrectomy were randomized to receive either combined general-subcostal TAP anesthesia (group TAP), combined general-epidural anesthesia (group EA), or general anesthesia (group GA), and were analyzed on an intention-to-treat basis. In group TAP, a bilateral subcostal TAP block was performed after induction of general anesthesia using 20 mL of 0.375% ropivacaine. In group EA, a thoracic epidural was placed between T8 and T9 and bolused with 8 mL of 0.25% ropivacaine before induction of general anesthesia. The epidural was maintained with 5 mL/h of 0.25% ropivacaine during the surgery. Group GA received standard general anesthesia. In the postanesthesia care unit (PACU), all groups received IV morphine titration for visual analog scale (VAS) pain scores >3. All patients were started on IV patient-controlled analgesia with morphine after morphine titration in the PACU, while group EA also had their epidural maintained with 5 mL/h of 0.125% bupivacaine with 8 g/mL morphine. Patients were assessed in the PACU and at 1, 3, 6, 24, 48, and 72 hours postoperatively. Primary outcomes measured were morphine consumption at 24 hours and all VAS pain scores. RESULTS: Data from 82 of 90 (91.1%) patients were included in the study. Group TAP demonstrated decreased cumulative morphine consumption at 24 hours (98.75% confidence intervals, -29 to -9 mg) and noninferiority on VAS pain scores at all measurement times, as compared with group GA with standard opioid analgesia. However, group EA was superior to group TAP regarding cumulative morphine consumption at 24 hours (98.75% confidence intervals, -23 to -4 mg) and noninferior to group TAP on VAS pain scores at all comparison points. Group TAP had reduced morphine consumption from PACU admission to 6 hours as compared with group GA, but increased morphine consumption for 6 to 24 hours as compared with group EA. CONCLUSION: Single-injection subcostal TAP block was more effective than IV opioid analgesia, while continuous thoracic epidural analgesia was more effective than the single-injection subcostal TAP block.
引用
收藏
页码:507 / 513
页数:7
相关论文
共 22 条
[1]   Predictive factors of severe postoperative pain in the postanesthesia care unit [J].
Aubrun, Frederic ;
Valade, Nathalie ;
Coriat, Pierre ;
Riou, Bruno .
ANESTHESIA AND ANALGESIA, 2008, 106 (05) :1535-1541
[2]   Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples [J].
Austin, Peter C. .
STATISTICS IN MEDICINE, 2009, 28 (25) :3083-3107
[3]   Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: a cadaveric study [J].
Barrington, M. J. ;
Ivanusic, J. J. ;
Rozen, W. M. ;
Hebbard, P. .
ANAESTHESIA, 2009, 64 (07) :745-750
[4]   The Transversus Abdominis Plane Block Provides Effective Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy [J].
Carney, John ;
McDonnell, John G. ;
Ochana, Alan ;
Bhinder, Raj ;
Laffey, John G. .
ANESTHESIA AND ANALGESIA, 2008, 107 (06) :2056-2060
[5]   Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery [J].
Charlton, Shona ;
Cyna, Allan M. ;
Middleton, Philippa ;
Griffiths, James D. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2010, (12)
[6]   Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy [J].
El-Dawlatly, A. A. ;
Turkistani, A. ;
Kettner, S. C. ;
Machata, A. -M. ;
Delvi, M. B. ;
Thallaj, A. ;
Kapral, S. ;
Marhofer, P. .
BRITISH JOURNAL OF ANAESTHESIA, 2009, 102 (06) :763-767
[7]   Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy [J].
Forastiere, E. ;
Sofra, M. ;
Giannarelli, D. ;
Fabrizi, L. ;
Simone, G. .
BRITISH JOURNAL OF ANAESTHESIA, 2008, 101 (06) :841-847
[8]   Acute opioid tolerance - Intraoperative remifentanil increases postoperative pain and morphine requirement [J].
Guignard, B ;
Bossard, AE ;
Coste, C ;
Sessler, DI ;
Lebrault, C ;
Alfonsi, P ;
Fletcher, D ;
Chauvin, M .
ANESTHESIOLOGY, 2000, 93 (02) :409-417
[9]   Subcostal transversus abdominis plane block under ultrasound guidance [J].
Hebbard, Peter .
ANESTHESIA AND ANALGESIA, 2008, 106 (02) :674-675
[10]   Ultrasound-Guided Continuous Oblique Subcostal Transversus Abdominis Plane Blockade Description of Anatomy and Clinical Technique [J].
Hebbard, Peter D. ;
Barrington, Michael J. ;
Vasey, Carolyn .
REGIONAL ANESTHESIA AND PAIN MEDICINE, 2010, 35 (05) :436-441