不同浓度罗哌卡因在超声引导下腹横筋膜阻滞用于剖宫产术后镇痛效果的临床观察

Analgesic effects of different concentrations of ropivacaine under ultrasound-guided transverse abdominal fascia block after cesarean section

目的观察剖宫产术后进行腹横筋膜阻滞(transverse abdominal fascia block,TAP)阻滞时应用不同浓度罗哌卡因镇痛效果的差异性。方法选择我院自2019年1~6月120例剖宫产患者,随机分为A、B、C组,每组40例。麻醉方式均采用腰硬联合阻滞。术毕进行TAP阻滞,A、B、C三组分别予0.4%、0.5%、0.6%浓度罗哌卡因40 mL。术后患者均口服双氯酸芬钾50 mg/6 h。如服药期间不能维持疼痛数字评价量表(number rating scale,NRS)评分≤4分,静脉注射曲马多。记录患者术后48 h内的静息、运动状态NRS评分及阿片类药物使用剂量及首次下地、首次排气时间及恶心、呕吐发生情况,镇静程度(Ramsay评分法)及术后镇痛满意度。结果术后24 h,A组静息状态NRS评分明显高于B、C两组,术后36 h,A组静息和运动状态NRS评分明显高于B、C两组,差异具有统计学意义(P<0.05)。术后24~36 h,A组曲马多使用量明显高于B、C两组,差异具有统计学意义(P<0.05)。而B、C组间,差异无统计学意义(P>0.05)。A、B、C三组患者首次下地时间、首次排气时间,恶心、呕吐,镇静程度及术后镇痛满意度比较,差异无统计学意义(P>0.05)。结论超声引导下双侧TAP阻滞使用0.5%罗哌卡因40 mL与使用0.4%浓度比较,能够提供长时效的镇痛,与0.6%浓度比较基本相当,因此更适合剖宫产术后镇痛。

Objective To observe the difference of analgesic effect of ropivacaine at different concentrations when transverse abdominal fascia block(TAP) performed after cesarean section. Methods 120 cesarean section patients treated in our hospital from January to June 2019 were randomly divided into three groups(groups A, B, and C), with 40 patients in each group. The anesthesia methods adopted combined spinal-epidural anesthesia(CSEA). After the operation,TAP block was performed, and the three groups were given 40 mL of ropivacaine at a concentration of 0.4%, 0.5%, and0.6%, respectively. All patients received oral diclofenac potassium 50 mg/6 h. If the pain cannot be endured during the medication, and the number rating scale(NRS) score was ≤4, tramadol was injected intravenously. The NRS scores in resting and exercise status and doses of opioids within 48 hours after surgery, first time getting out of bed, first aerofluxus time, occurrence of nausea and vomiting, degree of sedation(Ramsay score), and postoperative analgesia satisfaction were recorded. Results At 24 hours after surgery, the resting NRS scores in group A were significantly higher than those in groups B and C. At 36 hours after surgery, the resting and exercise NRS scores in group A were significantly higher than those in groups B and C, and the difference was statistically significant(P<0.05). During 24 to 36 hours after surgery, the amount of tramadol used in group A was significantly higher than that in group B and group C from 24 to 36 hours after surgery, and the difference was statistically significant(P<0.05), while the difference between group B and group C was not statistically significant(P>0.05). There were no significant differences in the first time getting out of bed, first aerofluxus time, the occurrence of nausea and vomiting, the degree of sedation and satisfaction among groups A, B, and C(P>0.05). Conclusion As compared with 0.4% concentration, ultrasound-guided bilateral TAP block using 0.5% ropivacaine 40 mL can provide long-term analgesia, which is basically equivalent to 0.6% concentration, thus it is more suitable for postoperative cesarean analgesia.