双侧超声引导下不同浓度罗哌卡因腹横肌平面阻滞用于子宫肌瘤腹腔镜剔除术患者术后镇痛的效果比较

Effect of transversus abdominis plane block with different concentrations of ropivacaine guided by bilateral ultrasound on postoperative analgesia after laparoscopic myomectomy

目的探讨双侧超声引导下腹横肌平面阻滞中不同浓度罗哌卡因对子宫肌瘤腹腔镜剔除术患者术后镇痛效果的影响。方法抽取2021年1月至2022年7月于河南科技大学第一附属医院行子宫肌瘤腹腔镜剔除术的患者162例,均予以双侧超声引导下腹横肌平面阻滞方案进行镇痛,镇痛药物选用罗哌卡因,并根据罗哌卡因浓度分为0.25%组、0.20%组、0.15%组,每组54例。比较三组患者术前与镇痛1、12、24、48 h后平均动脉压(MAP)、心率(HR),比较三组镇痛后首次自主按压镇痛泵时间、按压镇痛泵次数、疼痛程度[参考视觉模拟评分法(VAS)评分],比较三组不良反应发生情况。结果术前,三组MAP、HR比较差异未见统计学意义(P>0.05);镇痛1、12、24 h后,MAP、HR水平均表现为0.15%组>0.20%组>0.25%组,差异有统计学意义(P<0.05)。0.15%组、0.20%组、0.25%组患者镇痛后首次自主按压镇痛泵时间依次增加,按压镇痛泵次数依次减少(P<0.05);镇痛4、8 h后,0.15%组、0.20%组、0.25%组VAS评分依次降低,三组间比较差异有统计学意义(P<0.05);镇痛12、24 h后,三组VAS评分比较差异未见统计学意义(P>0.05)。0.15%组、0.20%组、0.25%组不良反应发生率分别为5.56%(3/54)、14.81%(8/54)、16.67%(9/54),三组间比较差异未见统计学意义(P>0.05)。结论双侧超声引导下不同浓度罗哌卡因腹横肌平面阻滞用于子宫肌瘤腹腔镜剔除术后的镇痛效果存在差异,其中0.25%罗哌卡因镇痛效果最好,且安全性好。

Objective To investigate the effect of transversus abdominis plane block with different concentrations of ropivacaine guided by bilateral ultrasound on postoperative analgesia after laparoscopic myomectomy.Methods A total of 162 patients who underwent laparoscopic myomectomy in the First Affiliated Hospital of Henan University of Science and Technology from January 2021 to July 2022 were selected,and all patients received bilateral ultrasound guided transversus abdominis plane block regimen for analgesia,the analgesic drug was ropivacaine.According to the concentrations of ropivacaine,the patients were divided into 0.25%group,0.20%group,and 0.15%group,with 54 cases in each group.The mean arterial pressure(MAP)and heart rate(HR)before surgery and after 1,12,24,and 48 hours of analgesia were compared among the three groups.The time of first pressing patient-controlled analgesia pump,frequency of pressing analgesia pump and degree of pain after analgesia assessed by visual analogue scale(VAS)score were compared among the three groups.And the occurrence of adverse reactions of the three groups were compared.Results Before surgery,there was no statistically significant difference in MAP and HR among the three groups(P>0.05).After 1,12,and 24 hours of analgesia,the MAP and HR decreased in the order of 0.15%group,0.20%group,and 0.25%group,with statistically significant differences(P<0.05).After analgesia,the time of first pressing patient-controlled analgesia pump increased in the order of 0.15%group,0.20%group,and 0.25%group,and the frequency of pressing analgesia pump decreased in the same order(P<0.05).After 4 and 8 hours of analgesia,the VAS scores decreased in the order of 0.15%group,0.20%group,and 0.25%group,and there was a statistically significant difference among the three groups(P<0.05);however,after 12 and 24 hours of analgesia,there was no statistically significant difference in VAS scores among the three groups(P>0.05).There was no significant difference in the incidence of adverse reactions among the 0.15%group(5.56%,3/54),0.20%group(14.81%,8/54),and 0.25%group(16.67%,9/54),P>0.05.Conclusions There are differences in the analgesic effects of bilateral ultrasound guided transversus abdominis plane block with different concentrations of ropivacaine after laparoscopic myomectomy.Block with 0.25%ropivacaine have the best analgesic effect and good safety.