腹横肌平面阻滞在腹部手术应用的研究进展
Research Progress of the Application of Transversus Abdominis Plane Block in Abdominal Surgery
DOI: 10.12677/acm.2025.15123373, PDF,    科研立项经费支持
作者: 周 玲：汕头大学医学院，广东 汕头；梁 冰, 曹 阳*：暨南大学附属广州市红十字会医院麻醉科，广东 广州
关键词: 腹横肌平面阻滞；多模式镇痛；超声引导；腹部手术；TAPB； Multimodal Analgesia； Ultrasound Technology Guidance； Abdominal Surgery
摘要: 腹横肌平面阻滞(transversus abdominis plane block, TAPB)可以有效地阻滞患者腹部手术创伤所带来的躯体性疼痛。TAPB的实现可以由盲穿、超声技术引导、腹腔镜辅助完成。不同的穿刺入路所阻滞的神经节段也有所不同，临床中需要根据腹部手术部位的不同选择合适的穿刺入径。TAPB的用药包括局麻药物和佐剂，局麻药物包括了罗哌卡因、布比卡因等，佐剂则有右美托咪定和地塞米松等。TAPB应用广泛，除了是多模式镇痛中的一员，也是高危患者的麻醉替代选择。未来，TAPB的运用联合AI辅助超声识别技术、机器人辅助操作技术将会有更广阔的前景。
Abstract: The transversus abdominis plane block (TAPB) can effectively block the somatic pain caused by abdominal surgical trauma. The application of TAPB can be achieved by blind puncture, ultrasound technology guidance, and laparoscopic assistance. The nerve segments blocked by different puncture approaches are also different, and it is necessary to choose the appropriate puncture approaches according to the different abdominal surgical sites. The drugs of TAPB include local anesthetic drugs and adjuvant drugs, local anesthetic drugs including ropivacaine, bupivacaine, etc., and adjuvant drugs including dexmedetomidine and dexamethasone. TAPB has a wide range of applications; it is not only a vital member of multimodal analgesia, but also plays an important role in high-risk patients. In the future, the application of TAPB combined with AI-assisted ultrasonic recognition technology and robot-assisted operation technology will have broader prospects.
文章引用：周玲, 梁冰, 曹阳. 腹横肌平面阻滞在腹部手术应用的研究进展[J]. 临床医学进展, 2025, 15(12): 16-24. https://doi.org/10.12677/acm.2025.15123373

参考文献

[1] Rafi, A.N. (2001) Abdominal Field Block: A New Approach via the Lumbar Triangle. Anaesthesia, 56, 1024-1026. [Google Scholar] [CrossRef] [PubMed]
[2] Mishra, L., Pani, N., Mishra, D. and Patel, N. (2013) Bilateral Transversus Abdominis Plane Block as a Sole Anesthetic Technique in Emergency Surgery for Perforative Peritonitis in a High Risk Patient. Journal of Anaesthesiology Clinical Pharmacology, 29, Article 540. [Google Scholar] [CrossRef] [PubMed]
[3] Siddiqui, K.M., Ali, M.A. and Salim, B. (2020) Transversus Abdominis Plane Block as a Sole Anesthetic Technique for Open Appendectomy in Patient with Treacher Collins Syndrome: A Case Report. Journal of Surgical Case Reports, 2020, rjaa431. [Google Scholar] [CrossRef] [PubMed]
[4] Kim, Y., Hyun, D., Kim, H. and Kim, J.S. (2020) Transversus Abdominis Plane Block as a Sole Anesthetic Technique for Evacuation of Rectus Abdominis Muscle Hematoma—A Case Report. Anesthesia and Pain Medicine, 15, 344-348. [Google Scholar] [CrossRef] [PubMed]
[5] Li, C., Shi, J. and Jia, H. (2023) Ultrasound-Guided Transversus Abdominis Plane Block as an Effective Anesthetic Technique for Transverse Colostomy in a High-Risk Elderly Patient: A Case Report. Frontiers in Medicine, 10, Article ID: 1102540. [Google Scholar] [CrossRef] [PubMed]
[6] Odonnell, B. (2006) The Transversus Abdominis Plane (TAP) Block in Open Retropubic Prostatectomy. Regional Anesthesia and Pain Medicine, 31, 91-91. [Google Scholar] [CrossRef] [PubMed]
[7] McDonnell, J.G., O’Donnell, B., Curley, G., Heffernan, A., Power, C. and Laffey, J.G. (2007) The Analgesic Efficacy of Transversus Abdominis Plane Block after Abdominal Surgery: A Prospective Randomized Controlled Trial. Anesthesia & Analgesia, 104, 193-197. [Google Scholar] [CrossRef] [PubMed]
[8] Jankovic, Z.B., du Feu, F.M. and McConnell, P. (2009) An Anatomical Study of the Transversus Abdominis Plane Block: Location of the Lumbar Triangle of Petit and Adjacent Nerves. Anesthesia & Analgesia, 109, 981-985. [Google Scholar] [CrossRef] [PubMed]
[9] Hebbard, P., Fujiwara, Y., Shibata, Y. and Royse, C. (2007) Ultrasound-Guided Transversus Abdominis Plane (TAP) Block. Anaesthesia and Intensive Care, 35, 616-617.
[10] John, M. and Ahmad, I. (2014) Preloading Bougies during Videolaryngoscopy. Anaesthesia, 70, 111-112. [Google Scholar] [CrossRef] [PubMed]
[11] Tsai, H., Yoshida, T., Chuang, T., Yang, S., Chang, C., Yao, H., et al. (2017) Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. BioMed Research International, 2017, 1-12. [Google Scholar] [CrossRef] [PubMed]
[12] Furuya, T., Kato, J., Yamamoto, Y., Hirose, N. and Suzuki, T. (2018) Comparison of Dermatomal Sensory Block Following Ultrasound-Guided Transversus Abdominis Plane Block by the Lateral and Posterior Approaches: A Randomized Controlled Trial. Journal of Anaesthesiology Clinical Pharmacology, 34, Article 205. [Google Scholar] [CrossRef] [PubMed]
[13] Wassef, M., Lee, D., Levine, J., Ross, R., Guend, H., Vandepitte, C., et al. (2013) Feasibility and Analgesic Efficacy of the Transversus Abdominis Plane Block after Single-Port Laparoscopy in Patients Having Bariatric Surgery. Journal of Pain Research, 6, 837-941. [Google Scholar] [CrossRef] [PubMed]
[14] Faiz, S.H.R., Alebouyeh, M.R., Derakhshan, P., Imani, F., Rahimzadeh, P. and Ghaderi Ashtiani, M. (2017) Comparison of Ultrasound-Guided Posterior Transversus Abdominis Plane Block and Lateral Transversus Abdominis Plane Block for Postoperative Pain Management in Patients Undergoing Cesarean Section: A Randomized Double-Blind Clinical Trial Study. Journal of Pain Research, 11, 5-9. [Google Scholar] [CrossRef] [PubMed]
[15] Yoshiyama, S., Ueshima, H., Sakai, R. and Otake, H. (2016) A Posterior TAP Block Provides More Effective Analgesia than a Lateral TAP Block in Patients Undergoing Laparoscopic Gynecologic Surgery: A Retrospective Study. Anesthesiology Research and Practice, 2016, 1-5. [Google Scholar] [CrossRef] [PubMed]
[16] Chetwood, A., Agrawal, S., Hrouda, D. and Doyle, P. (2011) Laparoscopic Assisted Transversus Abdominis Plane Block: A Novel Insertion Technique during Laparoscopic Nephrectomy. Anaesthesia, 66, 317-318. [Google Scholar] [CrossRef] [PubMed]
[17] Prabhakar, P., Ganapathi, H.P., Suresh, V., Farias, A. and Manoharan, M. (2023) Surgeon Administered Transversus Abdominis Plane Block: Anatomic Principles and Technique. Journal of Robotic Surgery, 17, 1193-1205. [Google Scholar] [CrossRef] [PubMed]
[18] Sun, N., Wang, S., Ma, P., Liu, S., Shao, A. and Xiong, L. (2017) Postoperative Analgesia by a Transversus Abdominis Plane Block Using Different Concentrations of Ropivacaine for Abdominal Surgery. The Clinical Journal of Pain, 33, 853-863. [Google Scholar] [CrossRef] [PubMed]
[19] Griffiths, J.D., Le, N.V., Grant, S., Bjorksten, A., Hebbard, P. and Royse, C. (2013) Symptomatic Local Anaesthetic Toxicity and Plasma Ropivacaine Concentrations after Transversus Abdominis Plane Block for Caesarean Section. British Journal of Anaesthesia, 110, 996-1000. [Google Scholar] [CrossRef] [PubMed]
[20] Hessian, E.C., Evans, B.E., Woods, J.A., Taylor, D.J., Kinkel, E. and Bjorksten, A.R. (2013) Plasma Ropivacaine Concentrations during Bilateral Transversus Abdominis Plane Infusions. British Journal of Anaesthesia, 111, 488-495. [Google Scholar] [CrossRef] [PubMed]
[21] Yeap, Y.L., Wolfe, J.W., Kroepfl, E., Fridell, J. and Powelson, J.A. (2020) Transversus Abdominis Plane (TAP) Block for Laparoscopic Live Donor Nephrectomy: Continuous Catheter Infusion Provides No Additional Analgesic Benefit over Single‐Injection Ropivacaine. Clinical Transplantation, 34, e13861. [Google Scholar] [CrossRef] [PubMed]
[22] Urman, R., Malik, O., Kaye, A., Kaye, A. and Belani, K. (2017) Emerging Roles of Liposomal Bupivacaine in Anesthesia Practice. Journal of Anaesthesiology Clinical Pharmacology, 33, Article 151. [Google Scholar] [CrossRef] [PubMed]
[23] Hutchins, J., Delaney, D., Vogel, R.I., Ghebre, R.G., Downs, L.S., Carson, L., et al. (2015) Ultrasound Guided Subcostal Transversus Abdominis Plane (TAP) Infiltration with Liposomal Bupivacaine for Patients Undergoing Robotic Assisted Hysterectomy: A Prospective Randomized Controlled Study. Gynecologic Oncology, 138, 609-613. [Google Scholar] [CrossRef] [PubMed]
[24] Robertson, T.C., Hall, K., Bear, S., Thompson, K.J., Kuwada, T. and Gersin, K.S. (2018) Transversus Abdominis Block Utilizing Liposomal Bupivacaine as a Non-Opioid Analgesic for Postoperative Pain Management. Surgical Endoscopy, 33, 2657-2662. [Google Scholar] [CrossRef] [PubMed]
[25] Hutchins, J., Argenta, P., Berg, A., Habeck, J., Kaizer, A. and Geller, M.A. (2019) Ultrasound-Guided Subcostal Transversus Abdominis Plane Block with Liposomal Bupivacaine Compared to Bupivacaine Infiltration for Patients Undergoing Robotic-Assisted and Laparoscopic Hysterectomy: A Prospective Randomized Study. Journal of Pain Research, 12, 2087-2094. [Google Scholar] [CrossRef] [PubMed]
[26] Fidkowski, C.W., Choksi, N. and Alsaden, M. (2021) A Randomized-Controlled Trial Comparing Liposomal Bupivacaine, Plain Bupivacaine, and the Mixture of Liposomal Bupivacaine and Plain Bupivacaine in Transversus Abdominus Plane Block for Postoperative Analgesia for Open Abdominal Hysterectomies. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 68, 773-781. [Google Scholar] [CrossRef] [PubMed]
[27] Liu, H., Qiu, D., Xu, D., Yang, J. and Teng, P. (2024) Recovery Quality of Transversus Abdominis Plane Block with Liposomal Bupivacaine after Cesarean Delivery: A Randomized Trial. Journal of Clinical Anesthesia, 99, Article 111608. [Google Scholar] [CrossRef] [PubMed]
[28] Katz, D., Song, J., Carangelo, M., Bergsma, T., Winston, R. and Landau, R. (2024) Simulated Bupivacaine Pharmacokinetics after Labor Epidural Analgesia Followed by Transversus Abdominis Plane Block with Liposomal Bupivacaine for Intrapartum Cesarean Delivery. Journal of Clinical Anesthesia, 99, Article 111589. [Google Scholar] [CrossRef] [PubMed]
[29] Mishra, M., Mishra, S. and Singh, S. (2017) Ultrasound-Guided Transversus Abdominis Plane Block: What Are the Benefits of Adding Dexmedetomidine to Ropivacaine? Saudi Journal of Anaesthesia, 11, Article 58. [Google Scholar] [CrossRef] [PubMed]
[30] Dang, A., Madangopal, R., Aggarwal, M. and Kumar, J. (2020) A Comparative Evaluation of Different Doses of Dexmedetomidine as an Adjuvant to Bupivacaine in Transversus Abdominis Plane Block for Postoperative Analgesia in Unilateral Inguinal Hernioplasty. Journal of Anaesthesiology Clinical Pharmacology, 36, Article 398. [Google Scholar] [CrossRef] [PubMed]
[31] Yang, P., Luo, Y., Lin, L., Zhang, H., Liu, Y. and Li, Y. (2020) The Efficacy of Transversus Abdominis Plane Block with or without Dexmedetomidine for Postoperative Analgesia in Renal Transplantation. a Randomized Controlled Trial. International Journal of Surgery, 79, 196-201. [Google Scholar] [CrossRef] [PubMed]
[32] Abo Elfadl, G.M., Ali, W.N., Ahmed, F.N., Abd el-Rady, N.M., Ali, A.M. and Abdel Rady, M.M. (2023) Add Dexmedetomidine to Levobupivacaine for Transversus Abdominis Plane Block in Elderly Patients Undergoing Inguinal Hernia Repair: Could It Make a Difference? A Randomised Trial. Journal of Perioperative Practice, 34, 339-346. [Google Scholar] [CrossRef] [PubMed]
[33] Garg, K., Bhardwaj, N., Yaddanapudi, S., Sen, I.M., Mathew, P.J. and Kanojia, R.P. (2021) Efficacy of Dexmedetomidine as an Adjunct to Ropivacaine in Transversus Abdominis Plane Block for Paediatric Laparoscopic Surgeries. Indian Journal of Anaesthesia, 65, S27-S33. [Google Scholar] [CrossRef] [PubMed]
[34] Abdallah, M.Y.Y. and Abdallah, M.Y.Y. (2022) Levobupivacaine versus Levobupivacaine Plus Dexmedetomidine in Transversus Abdominis Plane Block in Patients Undergoing Abdominal Aortic Surgery. Anesthesia Essays & Researches, 16, 154-159. [Google Scholar] [CrossRef] [PubMed]
[35] Gupta, A., Gupta, A. and Yadav, N. (2019) Effect of Dexamethasone as an Adjuvant to Ropivacaine on Duration and Quality of Analgesia in Ultrasound-Guided Transversus Abdominis Plane Block in Patients Undergoing Lower Segment Cesarean Section—A Prospective, Randomised, Single-Blinded Study. Indian Journal of Anaesthesia, 63, Article 469. [Google Scholar] [CrossRef] [PubMed]
[36] Aga, A., Abrar, M., Ashebir, Z., Seifu, A., Zewdu, D. and Teshome, D. (2021) The Use of Perineural Dexamethasone and Transverse Abdominal Plane Block for Postoperative Analgesia in Cesarean Section Operations under Spinal Anesthesia: An Observational Study. BMC Anesthesiology, 21, Article No. 292. [Google Scholar] [CrossRef] [PubMed]
[37] Kumar, G., Gnanasekar, N., Kurhekar, P., Raghuraman, M. and Prasad, T. (2018) Comparative Evaluation of Ropivacaine and Ropivacaine with Dexamethasone in Transverse Abdominis Plane Block for Lower Abdominal Surgeries: A Prospective, Randomized, Double-Blinded Study. Anesthesia: Essays and Researches, 12, Article 937. [Google Scholar] [CrossRef] [PubMed]
[38] Küçüksaraç, G., Arslan, K. and Sahin, A.S. (2024) Effect of Dexamethasone on Postoperative Analgesia Following the Transversus Abdominis Plane Block in Gynecological Laparotomies. Cureus, 16, e73814. [Google Scholar] [CrossRef] [PubMed]
[39] Chen, Q., An, R., Zhou, J. and Yang, B. (2018) Clinical Analgesic Efficacy of Dexamethasone as a Local Anesthetic Adjuvant for Transversus Abdominis Plane (TAP) Block: A Meta-Analysis. PLOS ONE, 13, e0198923. [Google Scholar] [CrossRef] [PubMed]
[40] Zhang, D., Zhou, C., Wei, D., Ge, L. and Li, Q. (2019) Dexamethasone Added to Local Anesthetics in Ultrasound-Guided Transversus Abdominis Plain (TAP) Block for Analgesia after Abdominal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLOS ONE, 14, e0209646. [Google Scholar] [CrossRef] [PubMed]
[41] Zhu, J., Wang, X., Gong, J., Sun, H., Zhao, X. and Gao, W. (2020) The Combination of Transversus Abdominis Plane Block and Rectus Sheath Block Reduced Postoperative Pain after Splenectomy: A Randomized Trial. BMC Anesthesiology, 20, Article No. 22. [Google Scholar] [CrossRef] [PubMed]
[42] Demir, H.B., Atalay, A., Uc, C., Fırat, Ö. and Ersin, S. (2022) Tension‐Free Inguinal Hernia Repair with Transversus Abdominis Plane (TAP) Block in Elderly High‐Risk Patients. ANZ Journal of Surgery, 92, 2500-2504. [Google Scholar] [CrossRef] [PubMed]
[43] Sivapurapu, V., Gopal, S.V. and Solomon, A. (2021) Determination of the Efficacy of Ultrasound-Guided Bilateral Transversus Abdominis Plane (US-TAP) Block in Laparoscopic Total Extraperitoneal (TEP) Repair of Unilateral Hernia Surgeries: A Randomized Controlled Trial. Journal of Anaesthesiology Clinical Pharmacology, 37, 475-480. [Google Scholar] [CrossRef] [PubMed]
[44] Bissolati, M., De Ruberto, S., Ferreri, A.A., Galfrascoli, E., Giusti, M.P. and Zappa, M.A. (2024) Ultrasound Guided-Transabdominal Plane Block (UG-TAPB) Reduces Pain, Opioid Consumption and PONV, and Is Associated with Faster Recovery for Patients Undergoing Bariatric Surgery: A Retrospective Analysis in a High-Volume Italian Center. Updates in Surgery, 77, 245-253. [Google Scholar] [CrossRef] [PubMed]

为你推荐