腹腔镜肝叶切除术治疗肝内胆管结石患者肋缘下腹横筋膜阻滞预先镇痛效果研究*

doi:10.3969/j.issn.1672-5069.2025.02.036

Abstract

Abstract: Objective The aim of this study was to observe analgesic efficacy of preemptive analgesia by subcostal transverse fascial block in patients with intrahepatic bile duct stones (IHBDS) undergoing laparoscopic hepatectomy (LH). Methods A total of consecutive 147 patients with IHBDS were encountered in our hospital between January 2021 and December 2023, and all patients underwent LH for removal of diseased liver lobe. Before anesthesia, patients were divided into two groups, 71 patients in the control received general intravenous anesthesia, while 76 patients in the observation group received preemptive analgesia with subcostal transverse fascial block and then the general anesthesia same as in the control. Visual analogue scale (VAS) was applied to assess post-operational pain, and serum epinephrine (E), norepinephrine (NE) and cortsisol (Cor) levels were assayed by ELISA. Results Intestinal function resumed and hospital stay in the observation were(2.1±0.9)d and (7.1±1.1)d, both much shorter than [(3.2±1.1)d and (8.5±1.3)d, respectively, P＜0.05] in the control; by 6 h and 24 h, resting VAS scores in the observation were (1.9±0.5) points and (2.2±0.5)points, both significantly lower than [(2.9±0.3)points and (2.8±0.5)points, respectively, P＜0.05], and VAS score at motion were (2.4±0.3) points and (2.6±0.5)points, both significantly lower than [(3.4±0.5)points and (3.4±0.7)points, P＜0.05] in the control; post-operationally, serum E and Cor levels in the observation were (200.1±27.4)pg/ml and (262.1±28.4)pg/ml, both much lower than [(240.3±33.5)pg/ml and (301.7±31.2)pg/ml, P＜0.05] in the control; there were no significant differences as respect to heart rates or mean arterial pressure at T1 to T4 in the two groups(P＞0.05), and there were also no significant differences respect to adverse effects in the two groups (9.8% vs. 7.8%, P＞0.05). Conclusion Preemptive analgesia by subcostal transverse fascial block could alleviate post-operational pain in patients with IHBDS undergoing LH, which might be related to inhibition of body inflammatory reactions.

Key words: Intrahepatic bile duct stone, Laparoscopic hepatectomy, Transverse fascial block, Subcostal approach, Preemptive analgesia

Wu Qian, Qi Shaoxia, Li Dong, et al. Preemptive analgesia by subcostal transverse fascial block in patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy[J]. Journal of Practical Hepatology, 2025, 28(2): 302-305.

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Preemptive analgesia by subcostal transverse fascial block in patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy

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