Rescue analgesia with a transversus abdominis plane block alleviates moderate-to-severe pain and improves oxygenation after abdominal surgery: a randomized controlled trial.

IF 2.5 Q2 CLINICAL NEUROLOGY Frontiers in pain research (Lausanne, Switzerland) Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI:10.3389/fpain.2024.1454665
Jingxian He, Shuai Qin, Yuwen Wang, Qiuping Ye, Penglei Wang, Ye Zhang, Yun Wu
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Abstract

Background: Abdominal surgery is a common surgical procedure that is frequently associated with substantial postoperative pain. However, rescue analgesia using opioids is associated with several adverse effects. The transversus abdominis plane block (TAPB) has been demonstrated to be effective as part of multimodal analgesia. This study aims to evaluate the effects of rescue analgesia using the TAPB following abdominal surgery.

Methods: Ninety patients undergoing abdominal surgery and reporting a numeric rating scale (NRS) score of cough pain ≥4 on the first postoperative day were randomized to receive either sufentanil or TAPB for rescue analgesia. Pain scores and arterial oxygen pressure (PaO2) were evaluated before and after the administration of rescue analgesia. Sleep quality and gastrointestinal function were assessed postoperatively. The primary outcome was the degree of pain relief on coughing 30 min after the administration of rescue analgesia.

Results: Patients of both groups reported a significantly reduced NRS score on coughing 30 min after receiving rescue analgesia (P paired < 0.001 for both groups). Notably, the degree of pain relief was significantly higher in the TAPB group than in the sufentanil group [median (interquartile range), -3 (-4 to -2) vs. -2 (-2 to -1), median difference = -1; 95% confidence interval, -2 to -1; P < 0.001]. Moreover, patients in the TAPB group experienced less pain than those in the sufentanil group during the following 24 h. When evaluated, PaO2 increased significantly after rescue analgesia was administered in the TAPB group (P paired < 0.001); however, there were no significant intragroup differences in the sufentanil group (P paired = 0.129). Patients receiving the TAPB experienced better quality of sleep than those receiving sufentanil (P = 0.008), while no statistical differences in gastrointestinal function were observed between the two groups.

Conclusion: Rescue analgesia with the TAPB on the first postoperative day alleviated pain, enhanced oxygenation, and improved sleep quality in patients undergoing abdominal surgery; however, its effect on gastrointestinal function requires further research.

Clinical trial registration: This study was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=170983, ChiCTR2200060285) on 26 May 2022: Patients were recruited during the period between 30 May 2022 and 14 February 2023, and a follow-up of the last enrolled patient was completed on 16 March 2023.

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腹横肌平面阻滞镇痛可减轻腹部手术后的中度至重度疼痛并改善氧合:随机对照试验。
背景:腹部手术是一种常见的外科手术,经常伴有剧烈的术后疼痛。然而,使用阿片类药物进行抢救性镇痛会产生一些不良反应。作为多模式镇痛的一部分,腹横肌平面阻滞(TAPB)已被证明是有效的。本研究旨在评估腹部手术后使用腹横肌平面阻滞进行抢救性镇痛的效果:方法:90 名接受腹部手术且术后第一天咳嗽疼痛评分≥4 分的患者随机接受舒芬太尼或 TAPB 进行镇痛。在使用镇痛抢救前后对疼痛评分和动脉氧压(PaO2)进行了评估。术后对睡眠质量和胃肠功能进行了评估。主要结果是使用镇痛剂 30 分钟后咳嗽时疼痛的缓解程度:结果:两组患者在接受镇痛抢救 30 分钟后咳嗽的 NRS 评分均明显降低(TAPB 组患者在镇痛抢救后咳嗽的 NRS 评分明显升高(P 2 = 0.129))。与接受舒芬太尼镇痛的患者相比,接受TAPB镇痛的患者的睡眠质量更好(P = 0.008),而两组患者的胃肠功能没有统计学差异:结论:术后第一天使用 TAPB 进行镇痛可减轻腹部手术患者的疼痛,增强氧合,改善睡眠质量;但其对胃肠功能的影响还需进一步研究:本研究于 2022 年 5 月 26 日在中国临床试验注册中心(https://www.chictr.org.cn/showproj.html?proj=170983,ChiCTR2200060285)注册:患者招募时间为 2022 年 5 月 30 日至 2023 年 2 月 14 日,最后一名入组患者的随访于 2023 年 3 月 16 日完成。
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