Clinical observation of modified lower costa surgical approach for transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheterization / 中国医师进修杂志

ABSTRACT

Objective:To explore the safety and effectiveness of modified lower costa surgical approach (mLS) for transversus abdominis plane block (TAPB) combined with rectus sheath block (RSB) in surgical incision peritoneal dialysis catheterization (PDC).Methods:Forty chronic kidney disease of stage 5 patients scheduled for PDC from January to December 2018 in Huadu District People′s Hospital of Guangzhou City were selected. The patients were divided into 3 groups by random digits table method, among whom 13 cases used mLS for TAPB combined with RSB (TAPB combined with RSB group), 13 cases used lateral approach combined with hip approach for TAPB (TAPB group), and 14 cases used local anesthesia (LA group). The mean arterial pressure, heart rate and pain visual analogue score (VAS) at skin incision (T 0), separation of rectus abdominis (T 1), peritoneal dialysis catheter placement (T 2) and suture of skin and subcutaneous tunnel (T 3) were recorded; and the total operation and anesthesia time, cases of rescue anesthesia, surgeon′s satisfaction with anesthesia, surgical and anesthesia related complication were recorded. Results:The VAS from T 0 to T 3 in TAPB combined with RSB group and TAPB group was significantly lower than that in LA group (1.92 ± 0.95) and (3.00 ± 1.08) scores vs. (5.07 ± 0.62) scores, (1.31 ± 0.63) and (2.54 ± 0.66) scores vs. (3.86 ± 0.77) scores, (0.85 ± 0.69) and (1.77 ± 0.93) scores vs. (3.71 ± 0.61) scores, (1.38 ± 0.77) and (1.38 ± 0.87) scores vs. (3.64 ± 0.17) scores, the VAS of T 1 in TAPB combined with RSB group was significantly lower than that in TAPB group, and there were statistical differences ( P<0.05). There were no statistical differences in mean arterial pressure and heart rate among 3 groups ( P>0.05). The surgeon′s satisfaction with anesthesia from T 0 to T 3 in TAPB combined with RSB group and TAPB group were significantly higher than that in LA group (3.12 ± 0.76) and (3.11 ± 0.65) scores vs. (2.09 ± 0.61) scores, (3.09 ± 0.82) and (2.68 ± 0.75) scores vs. (1.99 ± 0.66) scores, (3.35 ± 0.82) and (3.31 ± 0.75) scores vs. (2.37 ± 0.73) scores, (3.02 ± 0.82) and (3.01 ± 0.75) scores vs. (2.35 ± 0.63) scores, surgeon′s satisfaction with anesthesia of T 1 in TAPB combined with RSB group was significantly higher than that in TAPB group, and there were statistical differences ( P<0.05). The rescue anesthesia in LA group was in 2 cases. The total operation and anesthesia time in TAPB combined with RSB group was significantly shorter than that in TAPB group and LA group (45.08 ± 9.62) min vs. (74.46 ± 7.29) and (69.71 ± 13.25) min, that in LA group was significantly shorter than that in TAPB group, and there were statistical differences ( P<0.05). The patients of 3 groups had no surgical and anesthesia related complication. Conclusions:In surgical incision PDC with mLS for TAPB combined with RSB, the effectiveness of intraoperative anesthesia is accurate, the operation time is short, the surgeon′s satisfaction with anesthesia is high, the blood pressure and heart rate are stable, and the security is high.