超声引导下阴部神经阻滞联合椎管内镇痛在自然分娩术中的应用

Application of ultrasound-guided pudendal nerve block combined with intraspinal analgesia in natural childbirth

目的 评估超声引导下阴部神经阻滞在自然分娩术中的应用。方法 选取2021年3月至2022年10月在泉州市中医院自然分娩的初产妇80例,按随机数表法将入选者分为试验组40例和对照组40例。试验组采用超声引导下的阴部神经阻滞加硬膜外镇痛,对照组采用单纯硬膜外镇痛。比较两组产妇在宫口扩张3 cm前、椎管内镇痛后30 min、会阴侧切时和切口缝合时的视觉模拟评分法(VAS)评分,助产士追加会阴部局部浸润麻醉的产妇数,产妇自行按压镇痛次数,对两组产妇的满意度进行统计。结果 在第二产程中,试验组会阴侧切时和切口缝合时的VAS评分小于对照组,差异有统计学意义(P<0.05);试验组术中自行按压镇痛次数少于对照组,差异有统计学意义(P<0.05);试验组术中助产士追加会阴部局部浸润麻醉的产妇数少于对照组,差异有统计学意义(P<0.05);试验组产妇满意度高于对照组,差异有统计学意义(P<0.05)。结论 经超声引导下双侧阴部神经阻滞用于自然分娩术中镇痛效果好,优势明显,值得推广。

Objective To evaluate the application of ultrasound-guided pudendal nerve block combined with intraspinal analgesia in natural childbirth.Methods A total of 80 primiparas who underwent natural delivery in Quanzhou Hospital of Traditional Chinese Medicine from March 2021 to October 2022 were selected and divided into an experimental group(40 cases)and a control group(40 cases)according to the random number table method.The experimental group received the ultrasound-guided pudendal nerve block combined with epidural analgesia,while the control group received only epidural analgesia.The pain visual analogue scale(VAS)score before 3 cm dilation of the cervix opening,30 minutes after intraspinal analgesia,during lateral episiotomy,and during incision suturing between the two groups were compared.At the same time,the number of lying-in women who received additional local infiltration anesthesia in the perineum by midwives,and the number of times of self-pressure analgesia were compared.The satisfaction of the two groups was counted.Results In the second stage of labor,the VAS of the experimental group was lower than that of the control group in the comparison of lateral incision pain and suture pain after episiotomy,with statistically significant difference(P<0.05);The number of intraoperative self-pressure analgesia in the experimental group was less than that in the control group,with statistically significant difference(P<0.05);The number of lying-in women who received additional local infiltration anesthesia in the perineum by midwives in the experimental group was less than that in the control group,with statistically significant difference(P<0.05);The satisfaction of lying-in women in the experimental group was higher than that in the control group,with statistically significant difference(P<0.05).Conclusion The ultrasound-guided bilateral pudendal nerve block has a good analgesic effect with significant advantages during natural childbirth,which is worth promoting.