超声引导下腹横肌平面阻滞复合口服氨酚曲马多用于剖宫产术后镇痛的效果

Analgesic efficacy of ultrasound-guided transversus abdominis plane blocks combined with paracetamol and tramadol hydrochloride tablets in patients undergoing cesarean delivery

目的观察超声引导下腹横肌平面阻滞(TAPB)复合口服氨酚曲马多用于剖宫产术后镇痛的效果。方法择期硬膜外麻醉下行剖宫产手术产妇60例,随机分为两组,TAPB组和PCEA组。手术结束后,TAPB组行超声引导下双侧TAPB,分别注入0.25%罗哌卡因0.6ml/kg,并口服氨酚曲马多片,每次一片(每片含盐酸曲马多37.5mg,对乙酰氨基酚325mg),每8h一次;PCEA组采用0.125%罗哌卡因加1μg/ml舒芬太尼实施持续硬膜外镇痛,背景剂量8ml/h,每次按压3ml,锁定时间15min,每小时最高限量15ml。记录术后2、6、12、24和48h的VAS评分,及患者镇痛满意度和不良反应。结果与PCEA组比较,TAPB组术后6h和12h咳嗽时切口痛VAS评分明显降低(P<0.05),产妇镇痛满意度明显提高(P<0.05),运动阻滞发生率明显降低(P<0.01)。结论超声引导下TAPB复合口服氨酚曲马多用于剖宫产术后镇痛效果优于硬膜外镇痛。

Objective To evaluated analgesic efficacy of ultrasound-guided transversus abdominis plane block（TAPB） combined with paracetamol and tramadol hydrochloride tablets over the first 48 postoperative hours after cesarean delivery.Methods Sixty women undergoing elective cesarean delivery were randomized into two groups：group TAPB （n=30） received TAP block with ropivacaine combined with regular paracetamol and tramadol hydrochloride tablets by mouth,group PCEA （n=30） accepted PCEA for postoperative analgesia.All patients received a standard epidural anesthesia during surgery.At the end of surgery,patients in group TAPB received bilateral TAP block with 0.25％ ropivacaine 0.6 ml/kg （maximal dose 150 mg）,patients in group PCEA received patient-controlled epidural analgesia with 0.125％ ropivacaine and 1μg/ml sufentanil （background dose 8 rnl/h,PCA dose 3 ml,lockout time 15 min,hour dose limit 15 ml）.Each patient was assessed at 2,6,12,24,and 48 h postoperatively for visual analogue pain scores,satisfaction scores and side effects.Results We found significant differences in median （IQR） visual analogue scores for incision pain during coughing at 6 h between group TAPB [3.1 （1.6-5.1）] and group PCEA [4.2（2.3-6.5）] and at 12 h [3.3（2.1-5.7） and 4.3 （2.4-5.9）,respectively] （P＜0.05）.Satisfaction scores was significantly lower in group TAPB than in group PCEA（P＜0.05）.The incidence of motor blockade was reduced in group TAPB （P ＜ 0.01）.Conclusion The TAP block combined with regular paracetamol and tramadol hydrochloride tablets provided superior postoperative analgesia when compared with PCEA after elective cesarean delivery.