单次硬膜外阻滞与两种区域阻滞用于剖宫产术后镇痛效果的比较

Comparison of two regional nerve blocks with a single-dose epidural analgesia for post-cesarean analgesia after cesarean section

目的比较单次硬膜外阻滞(EA)、腰方肌阻滞(QLB)和髂腹下/髂腹股沟神经阻滞(IINB)用于剖宫产术后镇痛的效果。方法选择2020年11月至2021年3月择期腰-硬联合麻醉下行初次剖宫产术的单胎产妇87例,年龄23~42岁,BMI 21~37 kg/m^(2),ASAⅡ级,孕期37~42周。采用随机数字表法将产妇分为三组:EA组、QLB组和IINB组,每组29例。所有产妇术中麻醉方法及用药一致,术毕EA组予吗啡复合罗哌卡因单次硬膜外给药,QLB组和IINB组分别行超声引导下双侧QLB、双侧IINB,所有产妇连接静脉自控镇痛泵(PCIA)补救镇痛。记录术后6、12、24、48 h吗啡用量、静息和活动时NRS疼痛评分。记录首次按压镇痛泵时间及术后48 h内镇痛泵总按压次数。记录恶心呕吐、皮肤瘙痒例数及严重程度评分,记录过度镇静、呼吸抑制、尿潴留及下肢静脉血栓发生情况。结果与EA组比较,QLB组和IINB组术后12、24 h吗啡用量明显升高(P<0.05),术后48 h内镇痛泵总按压次数明显增多(P<0.05),QLB组和IINB组恶心呕吐和皮肤瘙痒发生率明显降低(P<0.05)。三组术后6、48 h吗啡用量、不同时点静息和活动时NRS疼痛评分、首次按压镇痛泵时间差异均无统计学意义。三组均未发生过度镇静、呼吸抑制、尿潴留及下肢静脉血栓。结论剖宫产术后单次硬膜外阻滞的镇痛效果较腰方肌阻滞和髂腹下/髂腹股沟神经阻滞好,但术后恶心呕吐和皮肤瘙痒发生率高,腰方肌阻滞和髂腹下/髂腹股沟神经阻滞镇痛效果相当。

Objective To compare the analgesic effects and related complications of a single-dose epidural analgesia(EA),quadratus lumborum block(QLB),and iliohypogastric/ilioinguinal nerve block(IINB)for post-cesarean analgesia.Methods Eighty-seven parturients from November 2020 to March 2021,undergoing first cesarean section under combined spinal-epidural anesthesia were selected,aged 23-42 years,BMI 21-37 kg/m^(2),ASA physical statusⅡ,gestational period 37-42 weeks,were randomly divided into three groups using random number table method:group EA,group QLB and group IINB,29 parturients in each group.At the end of operation,a single-dose epidural morphine combined with ropivacaine was administered in group EA,ultrasound-guided bilateral QLB and bilateral IINB were performed in group QLB and group IINB,respectively.All the parturients received morphine via patient-controlled intravenous analgesia(PCIA)pump for remedial analgesia.Morphine consumption and NRS scores at rest or during exercise 6,12,24,and 48 hours postoperation were recorded.The time when parturients use analgesia pump for the first time and the total times parturieuts used the pump within 48 hours were recorded.And related adverse reactions(nausea and vomiting,pruritus,excessive sedation,respiratory depression,urinary retention,and lower extremity venous thrombosis)were recorded.Results Compared with group EA,morphine consumption 12 and 24 hours after operation,and the total times parturients used the pump within 48 hours were increased significantly in groups QLB and IINB(P<0.05),the incidence of nausea and vomiting and pruritus were decreased significantly in groups QLB and IINB(P<0.05).There were no significantly differences of morphine consumption 6 and 48 hours after operation,NRS scores at rest and during exercise 6,12,24,and 48 hours postoperatively and the time using analgesia pump for the first time in the three groups.There were no excessive sedation,respiratory depression,urinary retention,or lower extremity venous thrombosis happened in the three groups.Conclusion The analgesic effect of a single-dose epidural analgesia after cesarean section is superior than that of QLB and IINB.However,the incidence of postoperative nausea-vomiting and pruritus is higher in epidural morphine.The analgesic effect of QLB and IINB is similar.