关键词:

腹横肌平面阻滞 , 竖脊肌平面阻滞 , 肝移植 , 疼痛

Abstract:

Objective To evaluate the effect of preoperative B-ultrasound-leaded transversus abdominisplane block（TAPB）or erector spinae plane block（ESPB）combining with patient controlled intravenous analgesia （PCIA）on postoperative analgesia in patients undergoing orthotopic liver transplantation. Methods Forty-five patients with modified piggy-back orthotopic livertransplantation were selected. The aged was 18 ～ 64 years old. The body mass index was 18 ～ 24 kg/m2，and the ASA grade was Ⅲ～Ⅴ . They were divided into 3 groups（n ＝ 15）：preoperative TAPB group，preoperative ESPB group and regular PCIA group（C group）. In the TAPB group，after the induction of general anesthesia，ultrasound-guided two-step TAPB was performed under the bilateral costal approach. Each point was injected with a mixture drug 15 ml（0.33% ropivacaine 30 ml + dexamethasone 5 mg）. In the ESPB group，after the induction of general anesthesia，ultrasound-guided bilateral TAPB was performed in T7. Each point was injected with a mixture drug 30 ml（0.33% ropivacaine 30 ml + dexamethasone 5 mg）. Group C was a conventional general anesthesia group，no nerve block was performed. Sufentanil 2 μg/kg PCIA was used in every groups，and the visual analog scale score（VAS）was maintained ≤ 3 within 48 h after operation. Sufentanil 5 μg was intravenously injected as rescue analgesic. The intraoperative consumption of remifentanil and the requirement for sufentanil as rescue analgesic were recorded. The extubation time after operation and development of nausea，vomiting，itching and respiratory depression were recorded within 48 h after surgery. Results Compared with group C，the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were both decreased in TAPB and ESPB groups. Also the time of extubation was shortened，and the adverse reactions were decrecing within two days after operation（P ＜ 0.05）. Compared with group TAPB，the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were decreased in ESPB group. But there were no significant difference of the time of extubation and the adverse reactions between the two groups within 48 h after operation（P ＞ 0.05）. Conclusion Preoperative ultrasound-guided TAPB or ESPB combining with PCIA can both provide better efficacy of postoperative analgesia with fewer adverse reactions in patients undergoing orthotopic liver transplantation. Compared with TAPB，the consumption of postoperative intravenous analgesic is decelerated in ESPB. 

Key words:

Transversus abdominis plane block , Erector spinae plane block , Liver transplantation, Pain