腹横肌平面阻滞联合静脉镇痛用于子宫下段剖宫产术后镇痛的效果

Effect of transversal plane block combined with intravenous analgesia on analgesia after caesarean section in lower uterus

目的观察腹横肌平面阻滞联合静脉镇痛用于子宫下段剖宫产术后镇痛的效果。方法选择2018年8月—2021年8月在广东省惠州市第三人民医院行子宫下段剖宫产术患者60例,采用随机数字表法分为试验组和对照组,每组30例。对照组患者行腰硬联合麻醉,术后行静脉自控镇痛,试验组患者在此基础上术毕时行超声引导腹横肌平面阻滞。比较2组患者术后4、6、12、24、48 h静息和咳嗽疼痛视觉模拟评分法(VAS)评分,首次PCA时间、PCA总次数、氟比洛芬酯补救镇痛率及麻醉镇痛相关不良反应。结果试验组患者术后4、6、12、24 h静息和咳嗽疼痛VAS评分均低于对照组(P<0.05);2组患者术后48 h静息和咳嗽疼痛VAS评分比较差异无统计学意义(P>0.05);试验组患者首次PCA时间长于对照组,PCA总次数少于对照组,氟比洛芬酯补救镇痛率低于对照组(P<0.01);2组患者均未发生麻醉镇痛相关不良反应。结论腹横肌平面阻滞用于子宫下段剖宫产术后镇痛安全有效,可降低术后24 h疼痛评分,减少镇痛药物使用量。

Objective To observe the analgesic effect of transversal plane block combined with intravenous analgesia on lower section of uterus after caesarean section.Methods 60 patients who underwent caesarean section in Huizhou Third People′s Hospital,Guangdong Province from August 2018 to August 2021 were selected and divided into experimental group and control group by random number table method,with 30 patients in each group.Patients in the control group received combined spinal and epidural anesthesia and postoperative patient-controlled intravenous analgesia.On this basis,patients in the experimental group received ultrasound-guided transversus abdominis plane block at the end of surgery.The resting and cough pain VAS scores at 4,6,12,24,48 h after surgery,the time of first PCA,the total number of PCA,the recovery analgesic rate of flurbiprofen exate and the analgesic related adverse reactions of the 2 groups were compared.Results Experimental group patients postoperative 4,6,12,24 h resting and cough pain VAS score were lower than control group(P<0.05);2 groups of patients postoperative 48 h resting and cough pain VAS score there were no statistically significant difference comparing(P>0.05);The time of first PCA in experimental group was longer than the control group,the total of PCA was less than the control group,flurbiprofen ester remedial analgesia rate was lower than the control group(P<0.01);No adverse reactions related to anesthesia and analgesia occurred in 2 groups.Conclusion The plane block of transverse abdominal muscle is safe and effective for postoperative analgesia after cesarean section in the lower segment of uterus,which can reduce the pain score at 24 hours after operation and reduce the use of analgesic drugs.