剖宫产术后布托啡诺静脉自控镇痛联合腰方肌阻滞或硬膜外吗啡镇痛效果的比较研究

Comparison of analgesic effect of butorphanol patient-controlled intravenous analgesia combined with quadratus lumborum block or epidural morphine analgesia after cesarean section

目的:比较剖宫产术后布托啡诺静脉自控镇痛(PCIA)联合超声引导腰方肌阻滞(QLB)或硬膜外注射吗啡的镇痛效果。方法:收集妊娠37~42周疤痕子宫行剖宫产的孕妇70例,年龄25~40岁,ASA分级Ⅱ级,采用随机数字法分为双侧腰方肌阻滞组和硬膜外注射吗啡组( n=35)。两组均行腰麻与硬膜外联合麻醉,双侧腰方肌阻滞组术毕在超声引导下行双侧QLB,每侧分别注射0.375%罗哌卡因20 ml;硬膜外注射吗啡组术毕经硬膜外导管注入吗啡3 mg。术后均行PCIA,镇痛泵配方为布托啡诺8 mg,以生理盐水稀释到100 ml。背景输注速度为2 ml/h,自控剂量为0.7 ml/次,锁定时间为15 min 。记录术后4、8、12、24、36、48 h静息和运动状态疼痛视觉模拟评分(VAS),48 h内PCIA有效按压次数、镇痛补救率、镇痛满意度评分及不良反应。 结果:术后24 h静息状态和术后12、24、36 h运动状态VAS评分,双侧腰方肌阻滞组均低于硬膜外注射吗啡组( P均<0.05)。硬膜外注射吗啡组术后12、24、36 h运动状态VAS评分均高于静息状态( P均<0.05);静息状态术后各时点VAS 0~3分的例数两组比较差异均无统计学意义( P均>0.05),而运动状态术后12、24、36 h时点VAS 0~3分例数双侧腰方肌阻滞组高于硬膜外注射吗啡组( P均<0.05);双侧腰方肌阻滞组头晕、恶心呕吐发生率均低于硬膜外注射吗啡组( P均<0.05),双侧腰方肌阻滞组PCIA有效按压次数较硬膜外注射吗啡组明显减少( P<0.05),两组镇痛补救率和镇痛满意度评分比较差异无统计学意义( P均>0.05)。 结论:布托啡诺PCIA联合超声引导QLB或硬膜外注射吗啡均可有效缓解剖宫产术后静息状态疼痛,与联合硬膜外注射吗啡相比,超声引导QLB术后运动状态镇痛效果更优,不良反应少。

To compare the analgesic effect of butorphanol by patient-controlled intravenous analgesia(PCIA)combined with ultrasound-guided quadratus lumborum block(QLB)or epidural morphine analgesia after cesarean section.Methods Seventy parturients scheduled for cesarean section with scar uterus,gestation 37-42 weeks,aged 25-40 years,ASA II were assigned into two groups(n=35 each)by a random number table method,butorphanol PCIA combined with QLB(group QLB)and combined with epidural morphine(group epidural morphine).Combined spinal and epidural analgesia was used in both groups.0.375%ropivacaine 20 ml were injected in each side respectively under ultrasound guidance at the end of the operation in the group QLB.Morphine 3 mg were injected into the epidural space at the end of the operation in group epidural morphine.PCIA contained butorphanol 8 mg diluted to 10O ml in normal saline,and the PCIA pump was set up to deliver background infusion at 2 ml/h and 0.7 ml bolus dose with 15 min lockout interval.The resting and moving visual analogue scale(VAS)were recorded at 4,8,12,24,36 and 48 h after the operation;the effective pressing times of analgesia pump,the rate of rescue analgesia,the degree of satisfaction with analgesic effect and the adverse reaction within 48 h after the operation were recorded.Results The resting.VAS at 24 h and the moving VAS at 12,24 and 36 h after the operation were significantly lower in the group QLB than those in the group epidural morphine(all P<0.05).The moving VAS were higher than the resting VAS at 12,24 and 36 h after operation in the group epidural morphine(all P<0.05).The number of cases with VAS 0-3 scores at each time point after the operation had no dfference between the two groups(all P>0.05),but it was higher at 12,24 and 36 h after the operation in the group QLB than that in the group epidural morphine(all P<0.05).The postoperative nausea and vomiting were lower in the group QLB than that in the group epidural morphine(all P<0.05).The effective pressing time of analgesia pump within 48 h after the operation were lower in the group QLB than that in the group epidural morphine(P<0.05).There was no significant difference between the two groups in the rate of rescue analgesia and the degree of satisfaction with analgesic effect within 48 h(all P>0.05).Conclusion PCIA with butorphanol combined with the ultrasound-guided QLB or epidural morphine analgesia can effectively relieve pain in the resting state after cesarean section,but combined with QLB get better analgesic effect in the moving state with fewer adverse reactions.