超声引导下舒芬太尼联合罗哌卡因行髂腹下髂腹股沟神经阻滞对剖宫产患者术后镇痛的影响

Ultrasound-Guided Effect of Sufentanil Combined with Ropivacaine on Postoperative Analgesia in Patients with Cesarean Section Under Iliohypogastric/Ilioinguinal Nerve Block

目的:观察超声引导下舒芬太尼联合罗哌卡因行髂腹下髂腹股沟神经阻滞(Iliohypogastric/Ilioinguinal Nerve Block,IINB)对剖宫产患者术后镇痛效果的影响及其安全性。方法:选择子宫下段横切口剖宫产术的患者80例(ASAⅠ~Ⅱ级),随机分为两组(n=40):生理盐水组(S组)及IINB组(I组)。两组患者均于术毕行双侧IINB,I组予罗哌卡因及舒芬太尼混合液(0.3%的罗哌卡因+舒芬太尼0.1μg/kg)20ml,S组注射等同体积的生理盐水。所有患者术后予1μg/ml的舒芬太尼PCIA,给药方式均按2ml/h速率连续给予背景剂量,自控剂量0.5ml,锁定时间15min。若VAS评分≥4分,给予曲马多30mg。分别记录术后2h、6h、12h、24h、36h的VAS评分,记录运动阻滞的持续时间、曲马多的消耗量、镇痛泵的按压次数,观察不良反应及神经阻滞相关并发症等的发生情况。结果:S组术后各时间点VAS评分高于I组(P<0.01);S组曲马多的消耗量为(82.5±33.1)mg,比I组的(23.3±18.6)高,差异有统计学意义(P<0.05);S组镇痛泵的按压次数为(18.3±5.2)次,比I组的(7.7±2.8)次多(P<0.05);S组恶心呕吐的发生率高于I组(P<0.05);I组运动阻滞持续时间与S组比较差异无统计学意义(P>0.05);两组患者未见其他不良反应和神经阻滞相关并发症。结论:超声引导下舒芬太尼联合罗哌卡因行双侧髂腹下髂腹股沟神经阻滞用于剖宫产术后镇痛,安全有效。

Objective：To observe the effect and safety of sufentanil combined with ropivacaine on the postoperative analgesia of cesarean section in patients with cesarean section under the guidance of ultrasound.Methods：80patients with ASAⅠ~Ⅱwere randomly divided into two groups（n=40）：normal saline group（S group）and IINB group（I group）.Two groups of patients were treated with bilateral IINB,group I to ropivacaine and sufentanil mixture（0.3% ropivacaine＋sufentanil 0.1μg/kg）20ml,S group injected with equivalent Volume of saline.All patients were given 1μg/ml of sufentanil PCIA,the mode of administration were given 2ml/h rate of continuous background dose,self-control dose0.5ml,locking time 15 min.If the VAS score is greater than or equal to 4points,patients will be given tramadol 30 mg.The VAS scores were recorded at 2h,6h,12 h,24hand 36 hafter operation.The duration of exercise block,the consumption of tramadol,the number of times of analgesic pump,the adverse reactions and the complications of nerve block were recorded.The occurrence of the situation.Results：The VAS score of group S was higher than that of group I（P〈0.01）.The consumption of tramadol in group S was（82.5±33.1）mg,which was significantly higher than that in group I（23.3±18.6）（P〈0.05）.The incidence of nausea and vomiting in group S was higher than that in group I（P〈0.05）;I was significantly higher than that in group I（7.7±2.8）.There was no significant difference between the two groups（P〉0.05）.There were no other adverse events and neurological block-related complications in the two groups.Conclusion：Ultrasonically guided sufentanil combined with ropivacaine used to treat analgesia after cesarean section was safe and effective.