右江医学2025，Vol.53Issue(11)：1010-1017,8.DOI:10.3969/j.issn.1003-1383.2025.11.007
艾司氯胺酮联合罗哌卡因TAP阻滞用于LTH的镇痛效果
Analgesic effect of esketamine combined with ropivacaine for TAP block in LTH
摘要
Abstract
Objective To investigate the analgesic efficacy of esketamine as an adjuvant to ropivacaine in ultrasound-guided transversus abdominis plane block(TAPB)for patients undergoing laparoscopic total hysterectomy(LTH).Methods A total of 80 patients scheduled for elective LTH from March to August 2024 were randomly divided into two groups:experimental group(RE group,n=40)and control group(R group,n=40).The RE group were given bilateral TAPB with 0.33%ropivacaine injection combined with 0.2 mg/kg esketamine in a total volume of 30 mL,while the R group were given bilateral TAPB with 30 mL of 0.33%ropivacaine alone.And then,the onset time and duration of sensory block,visual analog scale(VAS)scores at rest and during cough at different postoperative time points,number of times of remedial analgesia,15-item Quality of Recovery Scale(QoR-15)scores,and adverse reactions were compared between the two groups.Results Compared with the R group,the RE group showed significantly lower VAS scores at rest at 6 h(P<0.001)and 12 h(P<0.001),and during cough at 6 h(P<0.001),12 h(P<0.001),24 h(P=0.018),and 48 h(P=0.027)after surgery.The RE group exhibited significantly longer sensory block duration([594.3±77.4]min vs[451.3±44.6]min,P<0.001)compared to the R group,and the number of times of rescue analgesia in the anesthesia recovery room(1[2.5%]vs 8[20.0%],P=0.034)and ward(4[10.0%]vs 14[35.0%],P=0.007)was less than that in the R group.The RE group scored higher on the QoR-15 scale at 1 day([108.0±6.0]points vs[94.7±6.3]points,P<0.001)and 2 days([123.6±7.4]points vs[110.6±4.6]points,P<0.001)after surgery,and all differences were statisti-cally significant.There was no statistically significant difference in the incidence of adverse reactions and hemodynamic indi-cators between the two groups(P>0.05).Conclusion Adding 0.2 mg/kg esketamine to 0.33%ropivacaine for ultra-sound-guided bilateral TAPB can enhance early postoperative analgesia,prolong sensory blockade time,reduce the need for salvage analgesia,improve patients'subjective recovery quality scores,without increasing hemodynamic fluctuations or adverse reaction risks.关键词
艾司氯胺酮/腹横肌平面阻滞/罗哌卡因/腹腔镜全子宫切除术/术后镇痛Key words
esketamine/transversus abdominis plane block(TAPB)/ropivacaine/laparoscopic total hysterectomy(LTH)/postoperative analgesia分类
医药卫生引用本文复制引用
陈琳敏,杨铎,张欢楷,林耿彬,林璇,孙琪琪,叶淑君,张隆盛..艾司氯胺酮联合罗哌卡因TAP阻滞用于LTH的镇痛效果[J].右江医学,2025,53(11):1010-1017,8.基金项目
广东省医学科研基金立项项目(B2022294,A2021400) （B2022294,A2021400）
揭阳市卫生健康局医学科学技术研究立项项目(4452024040) （4452024040）
