腹横肌平面阻滞对女性腹腔镜胆囊切除术患者术后镇痛效果及围手术期阿片类药物消耗量的影响

Effect of transversus abdominis plane block on postoperative analgesia and perioperative opioid consumption in female patients undergoing laparoscopic cholecystectomy

摘要:

目的 评估超声引导腹横肌平面阻滞（TAPB）对女性腹腔镜胆囊切除术（LC）患者术后镇痛效果及围手术期阿片类药物消耗量的影响。方法 回顾性纳入2023年1月－2025年12月于该院行LC治疗的女性患者84例，根据麻醉及镇痛方式的不同，将其分成TAPB组42例和局麻组42例。其中，TAPB组于气管插管后实施超声引导下双侧TAPB，局麻组于切皮前行穿刺孔局部浸润麻醉。两组术后均采用患者自控静脉镇痛（PCIA）。比较两组术中瑞芬太尼消耗量、术后舒芬太尼消耗量、镇痛泵按压次数及补救镇痛实施比例。分别于术后2、6、12及24 h，采用视觉模拟评分法（VAS）及布鲁格曼舒适度量表（BCS）评价疼痛及舒适度。检测术前及术后12 h血清肾上腺素（AD）和皮质醇（Cor）水平。比较两组术后恢复情况、术后恶心呕吐（PONV）发生率及其他麻醉相关不良反应。结果 TAPB组术中瑞芬太尼消耗量、术后舒芬太尼消耗量和镇痛泵按压次数少于局麻组，补救镇痛实施比例低于局麻组，差异均有统计学意义（P < 0.05）。术后2、6、12及24 h，TAPB组VAS评分低于局麻组，BCS评分均高于局麻组，差异均有统计学意义（P < 0.05）。术后12 h，两组血清AD及Cor水平高于术前，但TAPB组低于局麻组，差异均有统计学意义（P < 0.05）。TAPB组住院时间短于局麻组，差异有统计学意义（P < 0.05）。两组意识恢复时间、气管拔管时间和麻醉恢复室（PACU）停留时间比较，差异均无统计学意义（P > 0.05）。TAPB组PONV发生率及止吐药使用率低于局麻组，差异均有统计学意义（P < 0.05）。两组头晕嗜睡、皮肤瘙痒、尿潴留及穿刺部位疼痛发生率比较，差异均无统计学意义（P > 0.05）。结论 超声引导下TAPB用于女性LC患者可改善术后镇痛效果，减少围手术期阿片类药物消耗，减轻应激反应，降低PONV发生率，具有一定的临床应用价值。

Abstract:

Objective To evaluate the effects of ultrasound-guided transversus abdominis plane block (TAPB) on postoperative analgesic efficacy and perioperative opioid consumption in female patients undergoing laparoscopic cholecystectomy (LC).Methods This retrospective analysis included 84 female patients who underwent LC at our hospital from January 2023 to December 2025. Depending on the anesthetic and analgesic approach, the patients were categorized into a TAPB group (n = 42) and a local infiltration anesthesia group (n = 42). After tracheal intubation, the TAPB group received bilateral ultrasound-guided TAPB, whereas the local infiltration anesthesia group received local infiltration anesthesia at the puncture sites before skin incision. Both groups received patient controlled intravenous analgesia (PCIA) after surgery. Intraoperative remifentanil consumption, postoperative sufentanil consumption, the number of analgesic pump presses, and the proportion of patients requiring rescue analgesia were compared between the two groups. Pain intensity and comfort level were assessed using the visual analogue scale (VAS) and Bruggemann comfort scale (BCS) at 2, 6, 12, and 24 h after surgery. Serum adrenaline (AD) and cortisol (Cor) levels were measured before surgery and at 12 h after surgery. Postoperative recovery parameters, postoperative nausea and vomiting (PONV), and other anesthesia- and analgesia-related adverse events were also compared between the two groups.Results Compared with the local infiltration anesthesia group, the TAPB group showed significantly less intraoperative remifentanil consumption, postoperative sufentanil consumption, the number of analgesic pump presses, and a lower proportion of patients requiring rescue analgesia, the differences were statistically significant (P < 0.05). At 2, 6, 12, and 24 h after surgery, VAS scores were significantly lower, whereas BCS scores were significantly higher, in the TAPB group than those in the local infiltration anesthesia group, The differences were statistically significant (P < 0.05). At 12 h after surgery, serum AD and Cor levels were significantly increased compared with preoperative levels in both groups, however, the increases were less pronounced in the TAPB group than in the local infiltration anesthesia group, and the difference was statistically significant (P < 0.05). The hospital stay was shorter in the TAPB group than in the local infiltration anesthesia group (P < 0.05). No significant differences were observed between the two groups in recovery time of consciousness, tracheal extubation time, or postanesthesia care unit (PACU) stay duration (P > 0.05). The incidence of PONV and antiemetic use in the TAPB group were significantly lower than those in the local infiltration anesthesia group (P < 0.05). No significant differences were observed between the two groups in the incidence of dizziness, drowsiness, pruritus, urinary retention, and puncture site pain (P > 0.05).Conclusion Ultrasound-guided TAPB can improve postoperative analgesic efficacy, reduce perioperative opioid consumption, alleviate stress responses, and decrease the incidence of PONV in female patients undergoing LC, suggesting potential clinical value.