TAP阻滞联合布托啡诺PCIA用于全麻剖宫产术后镇痛的效果

Efficacy of transversus abdominis plane block combined with butopenol PCIA for analgesia after cesarean section under general anesthesia

目的评价腹横肌平面(TAP)阻滞联合布托啡诺PCIA用于全麻剖宫产术后镇痛的效果。方法选取行全麻剖宫产术产妇90例,ASA分级Ⅰ或Ⅱ级,年龄18~42岁,体重52~88 kg,孕周38~42周,采用随机数字表法分为3组(n=30):TAP阻滞组(TAP组)、布托啡诺组PCIA(B组)和TAP阻滞联合布托啡诺PCIA组(TB组)。TAP组术毕在超声引导下行TAP阻滞,双侧分别注射0.375%罗哌卡因20 ml;B组于术毕前30 min静脉注射布托啡诺1 mg,术毕行PCIA,配方为布托啡诺8 mg+昂丹司琼8 mg,用氯化钠注射液稀释至100 ml,背景剂量2 ml/h,PCA剂量0.5 ml,锁定时间15 min;TB组于术毕前30 min静脉注射布托啡诺1 mg,术毕联合应用TAP阻滞和布托啡诺PCIA。术后VAS评分≥4分时,肌肉注射吗啡10 mg补救镇痛。记录术后48 h内吗啡使用情况;记录苏醒期间躁动和术后48 h内不良反应的发生情况。结果TAP组和TB组产妇均未见穿刺部位血肿及局麻药中毒等不良反应的发生。与TAP组比较,TB组术后寒战发生率和吗啡使用率降低(P<0.05);与B组比较,TB组术后恶心呕吐发生率和吗啡使用率降低(P<0.05)。结论TAP阻滞联合布托啡诺PCIA用于全麻剖宫产术后镇痛的效果优于单独应用TAP阻滞或布托啡诺PCIA。

Objective To evaluate the efficacy of transversus abdominis plane(TAP)block combined with butopenol patient-controlled intravenous analgesia(PCIA)for analgesia after cesarean section under general anesthesia.Methods Ninety American Society of Anesthesiologists physical statusⅠorⅡparturients,aged 18-42 yr,weighing 52-88 kg,at 38-42 weeks of gestation,scheduled for elective cesarean section under general anesthesia,were divided into 3 groups(n=30 each)using a random number table method:TAP block group(group TAP),butopenol PCIA group(group B)and TAP block plus butopenol PCIA group(group TB).In group TAP,bilateral TAP blocks were performed under ultrasound guidance at the end of surgery,and 0.375%ropivacaine 20 ml was injected into each side.In group B,butopenol 1 mg was intravenously injected at 30 min before the end of operation,PCIA was performed at the end of surgery,PCIA solution contained butopenol 8 mg and ondansetron 8 mg(diluted to 100 ml in sodium chloride injection),and the PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Butopenol 1 mg was intravenously injected at 30 min before the end of operation,and TAP block in combination with butopenol PCIA was performed at the end of operation in group TB.When the postoperative visual analog scale score was greater than or equal to 4 points,morphine 10 mg was intramuscularly injected as rescue analgesic.The requirement for morphine was recorded within 48 h after operation.The occurrence of agitation during emergence from anesthesia and adverse reactions within 48h after operation were also recorded.Results No adverse reactions such as hematoma at the puncture site or local anesthetic intoxication were observed in TAP group and TB group.Compared with group TAP,the incidence of postoperative shivering and requirement for morphine were significantly decreased in group TB(P<0.05).The incidence of postoperative nausea and vomiting and requirement for morphine were significantly lower in group TB than in group B(P<0.05).Conclusion The combination of TAP block and butopenol PCIA exerts better efficacy for analgesia after cesarean section under general anesthesia than either alone.