多模式镇痛超声引导下腹横肌阻滞用于剖宫产术后镇痛的效果观察

Effect of multimodal analgesia ultrasound-guided transverse abdominis plane block on postoperative analgesia after cesarean section

目的探讨多模式镇痛超声引导下腹横肌阻滞用于剖宫产术后镇痛效果。方法选取2018年6月至2020年5月于本院择期剖宫产手术患者60例作为研究对象,随机均分为多模式镇痛组(TS组)和静脉自控镇痛组(S组),每组30例。剖宫产手术结束后,TS组在超声下双侧腹横肌阻滞,每侧注射0.25%罗哌卡因20 ml,然后接入静脉自控止痛泵;S组直接接入静脉自控止痛泵,两组静脉泵参数设置相同。比较两组术后4、8、12、24、36、48 h镇痛效果[视觉模拟评分法(VAS)评分]及自控按压次数、不良反应、补救镇痛情况和患者满意度。结果两组VAS评分组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:术后8、12 h,两组VAS评分均高于术后4 h(P<0.05);术后48 h,两组VAS评分均低于术后4、8、12、24、36 h(P<0.05);术后12 h之后,两组VAS评分均呈下降趋势。组间比较:术后4、8、12、24、36 h,TS组VAS评分均低于S组,差异有统计学意义(P<0.05);术后48 h,两组VAS评分差异无统计学意义。TS组术后不良反应发生率低于S组,补救镇痛率低于S组,镇痛自控按压次数少于S组,差异有统计学意义(P<0.05);术后48 h随访,TS组镇痛满意度高于S组,差异有统计学意义(P<0.05)。结论多模式镇痛可有效缓解剖宫产术后术后疼痛,减少阿片类药物用量,且安全有效,并发症少,值得临床推广应用。

Objective Effect of multimodal analgesia ultrasound-guided transverse abdominis plane block on postoperative analgesia after cesarean section.Methods 60 patients with cesarean section in our hospital from June 2018 to May 2020 were selected as the research subjects,and they were divided into multimodal analgesia group(TS group)and intravenous-inhalation anesthesia group(S group),with 30 cases in each group.After the cesarean section,the TS group underwent bilateral transverse abdominal muscle block under ultrasound,and 20 ml of 0.25%ropivacaine was injected into each side,followed by intravenous self-control pain relief pump;S group was directly connected to the intravenous automatic analgesic pump,and the parameter settings of the two groups of venous pumps were the same.The analgesic effect(visual analog scale[VAS]score)at 4,8,12,24,36 and 48 h after surgery,the number of controlled compressions,adverse reactions,relief analgesia and patient satisfaction were compared between the two groups.Results There was statistically significant difference in VAS scores group,time and interaction between the two groups(P<0.05).Comparison within gorups:at 8 and 12 h after surgery,the VAS scores of the two groups were higher than those at 4 h after surgery(P<0.05);at 48 h after surgery,the VAS scores of the two groups were lower than those at 4,8,12,24,and 36 h after surgery(P<0.05);after 12 h of surgery,two groups showed downward trend in VAS scores.Comparison between groups:at 4,8,12,24,and 36 h after surgery,the VAS score of TS group was lower than that of S group,and the difference was statistically significant(P<0.05);at 48 h after surgery,there was no statistically significant difference in VAS scores between the two groups.The incidence of postoperative adverse reactions in the TS group was lower than that in the S group,the rate of salvage analgesia was lower than that in the S group,and the number of self-control compressions for analgesia was less than that in the S group,the difference was statistically significant(P<0.05);after 48 h of follow-up,the satisfaction with analgesia in the TS group was higher than that in the S group,the difference was statistically significant(P<0.05).Conclusion Multimodal analgesia can effectively relieve postoperative pain after cesarean section,reduce the dosage of opioids,and is safe and effective,fewer complications,which is worthy of clinical promotion and application.