腹横肌平面阻滞在腹腔镜术后镇痛效果中的研究进展
Research Progress on Analgesic Effect of Transversus Abdominis Plane Block after Laparoscopic Surgery
DOI: 10.12677/ACM.2023.132341, PDF,   
作者: 韩永晶, 贾 珍：青海大学附属医院麻醉科，青海 西宁
关键词: 腹横肌平面阻滞；腹腔镜手术；镇痛；Transversus Abdominis Plane Block； Laparoscopic Surgery； Analgesia
摘要: 近几年来，超声引导下的外周神经阻滞技术使用越来越广泛，也越来越成熟，相比于以前的盲探法来说，超声把盲探技术变为可视化的操作具有里程牌式的意义。超声引导下腹横肌平面神经阻滞具有可视化、穿刺失败可能性小、穿刺部位准确、减少穿刺并发症、为患者在术中以及术后提供良好的镇痛、减少术后并发症等优点，其对腹横肌平面阻滞效果总体提升具有较大价值，已经成为了临床麻醉中不可或缺的一部分，尤其是在腹腔镜手术中这些优点更为明显。本文就腹横肌平面阻滞在腹腔镜手术中应用的解剖结构、机制、不同入路、术中及术后镇痛效果、优点及不足进行综述，为其在腹腔镜术中的应用提供新思路。
Abstract: In recent years, the use of ultrasound-guided peripheral nerve block techniques has become more and more widespread and mature. Compared with the previous blind exploration method, ultra-sound has changed the blind exploration technique into a visualized operation with milestone sig-nificance, and ultrasound-guided transverses abdominis plane nerve block has the advantages of visualization, low possibility of puncture failure, accurate puncture site, reduction of puncture com-plications, providing patients with good analgesia during and after surgery, and reducing postoper-ative complications. It has become an integral part of clinical anesthesia, especially in laparoscopic surgery, because of its value in improving the overall effect of transversus abdominis plane block. In this paper, we review the anatomy, mechanism, different approaches, intraoperative and postoper-ative analgesic effects, advantages and shortcomings of transversus abdominis plane block in lapa-roscopic surgery to provide new ideas for its application in laparoscopic surgery.
文章引用：韩永晶, 贾珍. 腹横肌平面阻滞在腹腔镜术后镇痛效果中的研究进展[J]. 临床医学进展, 2023, 13(2): 2422-2427. https://doi.org/10.12677/ACM.2023.132341

参考文献

[1] Hamid, H. and Khan, I.Z. (2020) Anatomical Considerations for Transversus Abdominis Plane Block in Laparoscopic Surgery. The American Journal of Surgery, 219, 207-208. [Google Scholar] [CrossRef] [PubMed]
[2] Grape, S., Kirkham, K.R. and Albrecht, E. (2020) The Analge-sic Efficacy of Transversus Abdominis Plane Block after Bariatric Surgery: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. Obesity Surgery, 30, 4061-4070. [Google Scholar] [CrossRef] [PubMed]
[3] 王海振, 赵国庆, 李龙云, 等. 腹横肌平面阻滞对术后慢性疼痛的影响[J]. 中国实验诊断学, 2016, 20(8): 1411-1414.
[4] Priyadarshini, K., Behera, B.K., Tripathy, B.B., et al. (2022) Ultrasound-Guided Transverse Abdomi-nis Plane Block, Ilioinguinal/Iliohypogastric Nerve Block, and Quadratus Lumborum Block for Elective Open Inguinal Hernia Repair in Children: A Randomized Controlled Trial. Regional Anesthesia & Pain Medicine, 47, 217-221. [Google Scholar] [CrossRef] [PubMed]
[5] 张隆盛, 卢燕, 张楷弘, 等. 腰方肌阻滞与腹横肌平面阻滞应用于妇科腹腔镜术后镇痛效果的比较[J]. 河北医科大学学报, 2020, 41(12): 1450-1454.
[6] 王晓霞, 黄太满, 郭志鹏, 等. 斜肋下腹横肌平面阻滞用于腹腔镜胆囊切除术后的镇痛研究[J]. 安徽医药, 2018, 22(3): 425-429.
[7] 易红, 何睿, 周大春. 不同入路腹横肌平面阻滞的临床应用[J]. 临床麻醉学杂志, 2016, 32(5): 510-514.
[8] 袁帅, 崔敬禄, 熊东林, 等. 腹横肌平面阻滞药物扩散范围及治疗腹壁痛的效果[J]. 中国疼痛医学杂志, 2018, 24(10): 790-792.
[9] Parras, T. and Blanco, R. (2016) Randomised Trial Comparing the Transversus Abdominis Plane Block Posterior Approach or Quadratus Lumborum Block Type I with Femoral Block for Postoperative Analgesia in Femoral Neck Fracture, both Ultrasound-Guided. Revista Española de Anestesiología y Reanimación, 63, 141-148. [Google Scholar] [CrossRef] [PubMed]
[10] 马剑锋. 腹横肌平面阻滞范围及机理的探讨[D]: [博士学位论文]. 苏州: 苏州大学, 2017.
[11] Bryskin, R.B., Londergan, B., Wheatley, R., et al. (2015) Transversus Abdominis Plane Block versus Caudal Epidural for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Con-trolled Trial. Anesthesia & Analgesia, 121, 471-478. [Google Scholar] [CrossRef] 
[12] Tsai, H.C., Yoshida, T., Chuang, T.Y., et al. (2017) Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. BioMed Research International, 2017, Article ID: 8284363. [Google Scholar] [CrossRef] [PubMed]
[13] Hebbard, P. (2008) Subcostal Transversus Abdominis Plane Block un-der Ultrasound Guidance. Anesthesia & Analgesia, 106, 674-675. [Google Scholar] [CrossRef] [PubMed]
[14] Niraj, G., Searle, A., Mathews, M., et al. (2009) Analgesic Ef-ficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Patients Undergoing Open Appendicectomy. British Journal of Anaesthesia, 103, 601-605. [Google Scholar] [CrossRef] [PubMed]
[15] El-Dawlatly, A.A., Turkistani, A., Kettner, S.C., et al. (2009) Ultra-sound-Guided Transversus Abdominis Plane Block: Description of a New Technique and Comparison with Convention-al Systemic Analgesia during Laparoscopic Cholecystectomy. British Journal of Anaesthesia, 102, 763-767. [Google Scholar] [CrossRef] [PubMed]
[16] Rafi, A.N. (2001) Abdominal Field Block: A New Approach via the Lum-bar Triangle. Anaesthesia, 56, 1024-1026. [Google Scholar] [CrossRef] 
[17] Rozen, W.M., Tran, T.M., Ashton, M.W., et al. (2008) Refining the Course of the Thoracolumbar Nerves: A New Understanding of the Innervation of the Anterior Abdominal Wall. Clinical Anatomy, 21, 325-333. [Google Scholar] [CrossRef] [PubMed]
[18] 李杰, 刘超, 张玉河, 等. 超声引导下腹横肌平面阻滞在妇科腹腔镜手术术后镇痛中的应用效果[J]. 临床医学研究与实践, 2021, 6(20): 92-94.
[19] 张越, 徐岚, 张野. 子宫肌瘤患者开腹手术与腹腔镜手术术后的抑郁评分及预后[J]. 中国肿瘤临床与康复, 2019, 26(9): 1093-1095.
[20] Ali, S., Zarin, M., Jan, Z., et al. (2018) Effect of Bupivacaine on Postoperative Pain after Laparoscopic Cholecystectomy. Journal of College of Physicians and Surgeons Pakistan, 28, 663-666. [Google Scholar] [CrossRef] [PubMed]
[21] 孟元光. 腹腔镜在妇科领域的应用[J]. 腹腔镜外科杂志, 2012, 17(5): 395-397.
[22] Saway, J.P., McCaul, M., Mulekar, M.S., et al. (2022) Review of Outcomes of Low verses Standard Pressure Pneumoperitoneum in Laparoscopic Surgery. The American Surgeon, 88, 1832-1837. [Google Scholar] [CrossRef] [PubMed]
[23] 夏荣, 韩佩华. 腹腔镜胆囊切除术后疼痛的原因分析及防护措施[J]. 中国内镜杂志, 2004, 10(4): 56-57.
[24] 陈超, 颜学滔, 陈锋, 等. 术前不同容量罗哌卡因腹横肌平面阻滞对腹腔镜卵巢癌根治术患者术后镇痛的改良作用[J]. 中华麻醉学杂志, 2017, 37(12): 1418-1421.
[25] Hotta, K., Inoue, S., Taira, K., et al. (2016) Comparison of the Analgesic Effect between Continuous Wound Infiltration and Sin-gle-Injection Transversus Abdominis Plane Block after Gynecologic Laparotomy. Journal of Anesthesia, 30, 31-38. [Google Scholar] [CrossRef] [PubMed]
[26] 王庆福, 王伟, 宋少波, 等. 超声引导腹横肌筋膜神经阻滞复合全麻在腹腔镜手术中的应用效果[J]. 浙江创伤外科, 2021, 26(6): 1160-1162.
[27] Takebayashi, K., Matsumura, M., Kawai, Y., et al. (2015) Efficacy of Transversus Abdominis Plane Block and Rectus Sheath Block in Laparoscopic Inguinal Hernia Surgery. International Surgery, 100, 666-671. [Google Scholar] [CrossRef] 
[28] Tran, D.Q., Bravo, D., Leurcharusmee, P., et al. (2019) Transversus Abdominis Plane Block: A Narrative Review. Anesthesiology, 131, 1166-1190. [Google Scholar] [CrossRef] 
[29] 余伊, 徐磊, 鲍红光, 等. 超声引导下腹横肌平面阻滞对老年结直肠癌患者术中镇痛效果的应用观察[J]. 实用老年医学, 2015, 29(7): 552-554.
[30] Kokulu, S., Bakı, E.D., Kaçar, E., et al. (2014) Effect of Transversus Abdominis Plane Block on Cost of Laparoscopic Cholecystectomy Anesthesia. Medical Science Monitor, 20, 2783-2787. [Google Scholar] [CrossRef] 
[31] Vuong, J.T., McQuillan, P.M., Messaris, E., et al. (2014) Transversus Abdominis Plane Block as the Primary Anesthetic for Lapa-rotomy. Journal of Anaesthesiology Clinical Pharmacology, 30, 419-421. [Google Scholar] [CrossRef] [PubMed]
[32] Singh, M., Chin, K.J. and Chan, V. (2011) Ultrasound-Guided Transversus Abdominis Plane (TAP) Block: A Useful Adjunct in the Management of Postoperative Respiratory Failure. Journal of Clinical Anesthesia, 23, 303-306. [Google Scholar] [CrossRef] [PubMed]
[33] 陈培, 刘兰, 陈敏敏, 等. 罗哌卡因腹横肌平面阻滞对腹腔镜子宫肌瘤剔除术患者镇痛效果及应激反应的影响[J]. 中国内镜杂志, 2021, 27(4): 31-37.
[34] 洪玉, 刘嘉羿, 彭书崚, 等. 腹横肌平面阻滞在达芬奇机器人肝细胞癌切除术中的应用[J]. 中华肝脏外科手术学电子杂志, 2018, 7(4): 315-318.
[35] Rahiri, J., Tuhoe, J., Svirskis, D., et al. (2017) Systematic Review of the Systemic Concentrations of Local Anaesthetic after Transversus Abdominis Plane Block and Rectus Sheath Block. British Journal of Anaesthesia, 118, 517-526. [Google Scholar] [CrossRef] [PubMed]
[36] 庄伟强, 李冬慧, 谢文吉, 等. 超声引导下腹横肌平面阻滞联合双氯芬酸钠栓对腹腔镜下子宫切除患者术后早期恢复的影响[J]. 临床麻醉学杂志, 2018, 34(4): 363-366.
[37] 王芬, 胡臻, 周英杰. 不同麻醉镇痛方式对腹腔镜结直肠癌根治术患者术后转归的影响[J]. 临床麻醉学杂志, 2016, 32(1): 38-41.
[38] Johns, N, O’Neill, S., Ventham, N.T., et al. (2012) Clinical Effectiveness of Transversus Abdominis Plane (TAP) Block in Abdominal Surgery: A Systematic Review and Meta-Analysis. Colorectal Disease, 14, e635-642. [Google Scholar] [CrossRef] [PubMed]
[39] Forero, M., Heikkila, A., Paul, J.E., et al. (2015) Lumbar Transversus Abdominis Plane Block: The Role of Local Anesthetic Volume and Concentration—A Pilot, Prospective, Randomized, Controlled Trial. Pilot and Feasibility Studies, 1, 10. [Google Scholar] [CrossRef] [PubMed]
[40] 雷延芳. 不同浓度罗哌卡因腹横肌平面阻滞复合全麻在腹腔镜妇科手术中的应用效果观察[D]: [硕士学位论文]. 泰安: 山东第一医科大学, 2019.
[41] 白洁, 孟玮, 黄生辉. 腹腔镜胆囊切除术后不同浓度罗哌卡因腹横肌平面阻滞镇痛效果的随机对照研究[J]. 第三军医大学学报, 2017, 39(7): 696-700.
[42] Şahin, A.S., Ay, N., Şahbaz, N.A., et al. (2017) Analgesic Effects of Ultrasound-Guided Transverse Abdominis Plane Block Using Different Vol-umes and Concentrations of Local Analgesics after Laparoscopic Cholecystectomy. Journal of International Medical Re-search, 45, 211-219. [Google Scholar] [CrossRef] [PubMed]
[43] Ng, S.C., Habib, A.S., Sodha, S., et al. (2018) High-Dose versus Low-Dose Local Anaesthetic for Transversus Abdominis Plane Block Post-Caesarean Deliv-ery Analgesia: A Meta-Analysis. British Journal of Anaesthesia, 120, 252-263. [Google Scholar] [CrossRef] [PubMed]
[44] Carney, J., Finnerty, O., Rauf, J., et al. (2011) Studies on the Spread of Local Anaesthetic Solution in Transversus Abdominis Plane Blocks. Anaesthesia, 66, 1023-1030. [Google Scholar] [CrossRef] [PubMed]
[45] Lee, H., Chung, J., Lee, M., et al. (2019) Comparison be-tween Post-Operative Analgesic Efficacy of Low-Concentration High-Volume and High-Concentration Low-Volume Combinations of Ropivacaine for Transverse Abdominis Plane Block in Pediatric Open Inguinal Hernia Repair. Journal of Clinical Medicine, 8, 1133. [Google Scholar] [CrossRef] [PubMed]

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