超声引导下后路腹横肌平面阻滞对剖宫产术后镇痛的效果

Effect of ultrasound-guided posterior transversus abdominis plane block on analgesia after cesarean section

目的研究超声引导下后路腹横肌平面阻滞(TAPB)对剖宫产术后镇痛的效果。方法选取2019年7~10月于中山市博爱医院在腰硬联合麻醉下进行剖宫产术的60例产妇作为研究对象,按照随机数字表法将其分为实验组(30例)和对照组(30例)。两组术后均采用患者自控静脉镇痛(PCIA),实验组术毕实施超声引导下后路双侧TAPB。比较两组术后4、8、12、24、48 h静息和动态视觉模拟量表(VAS)评分、舒芬太尼用量、自控镇痛按压次数、不良反应发生情况、满意度评分,并观察实验组TAPB操作相关的并发症发生情况。结果实验组术后8、12、24 h的静息和动态VAS评分均低于对照组,术后0~23 h,实验组的舒芬太尼用量及自控镇痛按压次数均少于对照组,差异有统计学意义(P<0.05);实验组术后24~48 h的舒芬太尼用量少于对照组,满意度评分高于对照组,差异有统计学意义(P<0.05)。两组的不良反应(恶心呕吐、头晕、皮肤瘙痒、呼吸抑制、尿潴留)发生率比较,差异无统计学意义(P>0.05)。实验组未发生与TAPB操作相关的并发症。结论超声引导下后路TAPB能有效减轻产妇剖宫产术后疼痛,持续镇痛时间更长(24 h),且安全性、满意度较高。

Objective To study the effect of ultrasound-guided posterior transversus abdominis plane block(TAPB)on analgesia after cesarean section.Methods From July to October 2019,60 parturients undergoing cesarean section under the combined spinal and epidural anesthesia in Boai Hospital of Zhongshan were selected as the research objects and they were divided into the experimental group(30 cases)and the control group(30 cases)according to the random number table method.After the operation,both groups received patient-controlled intravenous analgesia(PCIA),and the experimental group received ultrasound-guided posterior TAPB after the operation.The rest and dynamic visual analogue scale(VAS)scores at 4,8,12,24,and 48 hours after surgery,the dosage of Sufentanil,the frequency of patient-controlled analgesia compressions,the occurrence of adverse reactions,and satisfaction score were compared between the two groups,and the occurrence of complications related to TAPB operation in the experimental group was observed.Results The rest and dynamic VAS scores of the experimental group at 8,12,and 24 hours after surgery were lower than those of the control group,at 0-23 hours after surgery,the dosage of Sufentanil and the frequency of self-controlled analgesia compressions in the experimental group were less than those in the control group,the differences were statistically significant(P<0.05).The dosage of Sufentanil in the experimental group was less than that in the control group at 24 to 48 hours after surgery,and the satisfaction score was higher than that in the control group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions(nausea and vomiting,dizziness,skin itching,respiratory depression and urinary retention)between the two groups(P>0.05).No complications related to TAPB operation occurred in the experimental group.Conclusion Ultrasound-guided posterior TAPB can effectively reduce the postoperative pain of parturients after cesarean section,with longer duration of analgesia(24 hours),higher safety and satisfaction.