腹腔镜辅助腹横肌平面阻滞与 切口局麻对腹腔镜阑尾切除术后镇痛效果的比较

Postoperative analgesic effect of laparoscopic-assisted transversus abdominis plane block versus wound infiltration in laparoscopic appendectomy

摘要

目的: 比较腹腔镜辅助腹横肌平面（Lap-Tap）阻滞与手术切口局部麻醉（WI）在腹腔镜阑尾切除术（LA）术后镇痛方面的有效性与安全性。方法 选择2021年8月至2025年5月行 LA 的 74 例急性阑尾炎患者,采用随机数字表法分为 Lap-Tap 组（n=38）与 WI 组（n=36）。Lap-Tap 组采用罗哌卡因完成 Lap-Tap 操作,腹部切口注射生理盐水;WI 组采用罗哌卡因切口注射,注射生理盐水完成Lap-Tap 操作。记录术后2h、6h、12h、24h、48h疼痛评分及补救性镇痛、首次下床活动时间、首次排气时间、相关并发症等。结果 两组术后2h、6h、12h、24h、48h疼痛评分及术后 48 h 内氟比洛芬酯用量、使用阿片类药物镇痛例数差异无统计学意义。两组均无操作相关并发症发生。结论 LA 术中采用 Lap-Tap 阻滞与 WI 在术后 48 h 内疼痛评分无明显差异。由于 WI 操作技术难度较低,可能更加适于 LA 术后局部镇痛。

Abstract

Objective: To compare the efficacy and safety of laparoscopic-assisted transversus abdominis plane（Lap-Tap） block versus wound infiltration（WI）for postoperative analgesia in laparoscopic appendectomy（LA）. Methods: A total of 74 patients with acute appendicitis who underwent LA from Aug. 2021 to May 2025 were enrolled and randomly divided into the Lap-Tap group （n=38）and the WI group（n=36）by means of the random number table method.Patients in the Lap-Tap group received Lap-Tap block with ropivacaine and saline injection at abdominal incisions, while those in the WI group received ropivacaine infiltration at surgi- cal incisions and saline injection for Lap-Tap block.Pain scores at 2h、6h、12h、24h、48h and 48 h after operation, as well as rescue analge- sia, time to first ambulation, time to first flatus, and related complications were recorded. Results: There were no statistically significant differences in pain scores at 2h、6h、12h、24h、48h and 48 h after operation, the dosage of flurbiprofen axetil within 48 h postoperatively, and the number of patients receiving opioid analgesia between the two groups.No procedure-related complications occurred in either group. Conclusions: No significant difference is found in pain scores within 48 h after operation between Lap-Tap block and WI during LA.WI may be more suitable for local postoperative analgesia in LA due to its lower technical difficulty.

关键词

麻醉 / 阑尾切除术 / 腹腔镜检查 / 腹横肌平面阻滞 / 镇痛

Key words

Anesthesia / Appendectomy / Laparoscopy / Transversus abdominis plane block / Analgesia