不同腹横肌平面阻滞应用时机对开腹子宫切除术麻醉及术后镇痛的效果比较被引量：10

下载PDF

导出

摘要目的对比开腹子宫切除术术前或术后应用腹横肌平面阻滞对麻醉及术后镇痛的效果。方法选取开腹子宫切除术的患者共90例,随机分为术前组和术后组,每组45例,分别在术前和术后应用超声引导下腹横肌平面阻滞,0.375%罗哌卡因20 mL每侧,在术后2、4、8、12、24和48 h采用疼痛视觉模拟VAS评分对两组患者分别在静息和运动(从平躺到坐起)评估镇痛程度,记录术中芬太尼使用量,术后在PACU及术后24 h吗啡用量的总量,对比两组患者采用腹横肌平面阻滞出现的相关并发症。结果术前组患者其术中的芬太尼用量、在PACU期间的吗啡用量及术后24 h的吗啡用量均显著低于术后组,差异有统计学意义(P<0.05),术前组在术后2 h和4 h静息和运动时的疼痛VAS评分均显著低于术后组,差异有统计学意义(P<0.05),术后8、12、24和48 h的疼痛VAS评分对比差异均无统计学意义(P>0.05),两组恶心呕吐的发生率对比差异无统计学意义(P>0.05),两组患者的PONV和镇静评分对比差异均无统计学意义(P>0.05)。结论术前进行腹横肌平面阻滞较术后进行腹横肌平面阻滞能显著减少术中芬太尼及术后吗啡用量,减轻术后早期疼痛,临床安全性良好。

作者刘国栋武建欧阳辉旺谢威王正坤淮诗媚刘吉平

机构地区佛山市妇幼保健院麻醉科

出处《广东医学》 CAS 2019年第10期1467-1470,共4页 Guangdong Medical Journal

关键词腹横肌平面阻滞术前子宫切除术镇痛麻醉

分类号 R614.4 [医药卫生—麻醉学] R713.42 [医药卫生—妇产科学]

引文网络
相关文献

参考文献7

1阮志慧,冯顺华,韩超,葛志军,赵海龙,马铁梁.术中持续输注右美托咪定对降低经腹子宫切除术后慢性疼痛的影响[J].临床麻醉学杂志,2017,33(12):1155-1158. 被引量：14
2张娜,肖珊珊,温娜,宋秀棉.加速康复管理在腹腔镜全子宫切除术患者中的应用研究[J].国际妇产科学杂志,2017,44(6):659-662. 被引量：39
3李晓丹,喻文立.加巴喷丁术前用药在开腹子宫切除术后镇痛效应的Meta分析[J].临床麻醉学杂志,2017,33(6):579-583. 被引量：2
4孙家铎,贺梦娇,张庆国.腹横肌平面阻滞在剖宫产术后镇痛的应用进展[J].广东医学,2018,39(S1):309-312. 被引量：10
5方兆晶,鲍红光,斯妍娜.右美托咪定混合罗哌卡因腹横肌平面阻滞在子宫切除术的应用[J].江苏医药,2016,42(22):2454-2457. 被引量：9
6黄生辉,李轶,杨小华,梁玉红,陈小东,华玉芳.超声引导下腹横肌平面阻滞和Trocar局部浸润在腔镜下子宫切除术后镇痛效应的对照性研究[J].第三军医大学学报,2015,37(18):1889-1891. 被引量：6
7沈阳,张海燕,李春林,张忠其.右美托咪定对超声引导下小儿腹横肌平面阻滞罗哌卡因浓度的影响[J].广东医学,2018,39(18):2820-2822. 被引量：17

二级参考文献21

1Nieboer T E, Hendriks J C, Bongers M Y, et al. Quality of life after laparoscopic and abdominal hysterectomy: a randomized controlled trial[J]. Obstet Gynecol, 2012, 119(1): 85-91.
2De-Oliveira G S Jr, Fitzgerald P, Streicher L F, et al. Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery[J]. Anesth Analg, 2012, 115(2): 262-267.
3Tam T, Harkins G, Wegrzyniak L, et al. Infiltration of bupivacaine local anesthetic to trocar insertion sites after laparoscopy: a randomized, double-blind, stratified, and controlled trial[J]. J Minim Invasive Gynecol, 2014, 21(6): 1015-1021.
4De-Oliveira G S Jr, Castro-Alves L J, Nader A, et al. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials[J]. Anesth Analg, 2014, 118(2): 454-463.
5Milan Z, Tabor D, McConnell P, et al. Three different approaches to Transversus abdominis planeblock: a cadaveric study[J]. Med Glas (Zenica), 2011, 8(2): 181-184.
6Abdallah F W, Laffey J G, Halpern S H, et al. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis[J]. Br J Anaesth, 2013, 111(5): 721-735.
7Akkaya A, Yildiz I, Tekelioglu U Y, et al. Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial[J]. Eur Rev Med Pharmacol Sci, 2014, 18(5): 717-722.
8Ortiz J, Suliburk J W, Wu K, et al. Bilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites[J]. Reg Anesth Pain Med, 2012, 37(2): 188-192.
9Tran T M, Ivanusic J J, Hebbard P, et al. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study[J]. Br J Anaesth, 2009, 102(1): 123-127.
10Kane S M, Garcia-Tomas V, Alejandro-Rodriguez M, et al. Randomized trial of transversus abdominis plane block at total laparoscopic hysterectomy: effect of regional analgesia on quality of recovery[J]. Am J Obstet Gynecol, 2012, 207(5): 419. e1-419. e5.