经腹横筋膜平面阻滞时使用不同浓度罗哌卡因对剖宫产术后镇痛效果的影响

Comparison of analgesic efficacy of TAP block using Ropivacaine with different concentration after caesarean delivery

目的 观察经腹横筋膜平面（TAP）阻滞时使用不同浓度罗哌卡因对剖宫产术后镇痛效果的差异。方法 本研究采用随机、对照、双盲的试验方法,选取66例行剖宫产手术患者。所有患者均接受腰硬联合麻醉。手术结束后行超声引导下双侧TAP阻滞,分别给予0.4%罗哌卡因40 m L（A组）、0.5%罗哌卡因40 m L（B组）及0.6%罗哌卡因40 m L（C组）,各22例。所有患者术后每6小时口服双氯芬酸钾50 mg至术后48 h。若服药间期最高疼痛数字评价量表（NRS）评分〉4分,静脉给予曲马多或肌注杜冷丁镇痛。患者术后48 h内评估静息及运动NRS评分,阿片类药物使用量;记录首次下地及首次排气时间;记录恶心、呕吐、过度镇静的发生情况及患者对术后镇痛方式的满意度。结果 A组患者术后24 h及36 h静息NRS评分明显较其他两组升高,且A组患者术后36 h时测得运动NRS评分明显高于其他两组,差异均有统计学意义（均P〈0.05）。A组患者在术后〉24~36 h曲马多使用量较其他两组明显增加（P〈0.05）。B、C组患者比较,NRS评分及阿片类药物使用量差异均无统计学意义（P〉0.05）。三组患者首次下地时间、首次排气时间及患者对镇痛方式满意程度、恶心、呕吐发生率及镇静评分比较,差异均无统计学意义（P〉0.05）。结论 与使用0.4%及0.6%罗哌卡因比较,使用0.5%罗哌卡因40 m L进行超声引导下双侧TAP阻滞更适用于剖宫产术后镇痛。

Objective To observe the difference of analgesic efficacy after caesarean delivery by transversus abdominis plane （TAP） block using different concentration of Ropivacaine. Methods A randomized, controlled, double blind trial was performed. 66 patients undergoing caesarean delivery were enrolled. All patients received a combined spinal- epidural anesthesia. The patients received bilateral US-guided TAP blocks with either 0.4% （group A）, 0.5% （group B） or 0.6% （group C） Ropivacaine 40 mL （n=22） at the end of surgeries followed by Diclofenac Potassium orally every 6 hs. Intravenous drip Tramadol or intramuscular injection Dolantin was given if maximum NRS score〉 4 scores. Each patient was assessed 48 h after delivery for resting or moving NRS scores, opioids usage; the time intervals to walk and venting were recorded, as well as the nausea, vomiting, drowsiness, and satisfaction with pain relief. Results Not only the resting NRS scores of the patients in group A were obviously higher than the other two groups at postoperative 24 h and 36 b, but also the moving NRS scores of the patients in group A were obviously higher than the other two groups at 36 h postoperative, with statistically significant difference （P 〈 0.05）. The mean doses of postoperative Tramadol con- sumption during 〉24-36 h in group A had increased obviously, compared with group B and C, there were statistically significant difference （P 〈 0.05）. There were no differences between group B and group C in NRS scores and opioid us- age （P 〉 0.05）. There were no differences in the time interval to walk and venting, the same as the incidence of nausea and vomiting, the Rcsmay scores and satisfaction with the analgesia among the three groups （P 〉 0.05）. Conclusion Compared with 0.4% and 0.6% Ropivacaine, 0.5% Ropivacaine 40 mL is more suitable for ultrasound guided bilateral TAP block used for analgesia after cesarean delivery.