超声引导下不同容量罗哌卡因腹横肌平面阻滞联合静脉镇痛在剖宫产术后镇痛效果的分析

Analysis of the Effect of Different Volumes of Ropivacaine Transverse Abdominal Muscle Plane Block Combined with Intravenous Analgesia under Ultrasound Guidance on Analgesia after Cesarean Delivery

目的 对剖宫产术产妇应用超声引导下不同容量罗哌卡因腹横肌平面(ttransverse abdominal muscle plane,TAP)阻滞联合静脉镇痛,分析其镇痛作用和不良反应,探索最佳容量。方法 随机选取2022年1—12月期间昆明医科大学第一附属医院收治的120例剖宫产产妇为研究对象,按照随机数表法分为对照组、A组、B组和C组,各30例,对照组是单纯静脉镇痛组,在对照组基础上,A组、B组、C组分别为每侧腹横肌平面0.25%罗哌卡因20、25、30 mL阻滞。术后2、6、12、24、36、48 h评估疼痛、舒适、镇静状况,并记录镇痛泵第1次按压时间、术后48 h镇痛泵总按压次数、术后24、48 h镇痛泵按压次数和经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)的用量及不良反应发生率。结果 C组术后36、48 h视觉模拟评分法(Visual Analogue Scale,VAS)评分均低于A组,C组术后48 h VAS评分均低于B组,差异有统计学意义(P<0.05)。术后24、36、48 h,C组舒适评分(Bruggrmann Comfort Scale,BCS)、Ramsay评分均高于对照组,差异有统计学意义(P<0.05)。术后36、48 h,C组BCS评分、Ramsay评分均高于A组,差异有统计学意义(P<0.05)。术后48 h,C组BCS评分、Ramsay评分高于B组,差异有统计学意义(P<0.05)。各组术后24 h镇痛泵按压次数、术后48 h镇痛泵按压次数、术后24 h PCIA用量、术后48 h PCIA用量均呈现降低趋势,差异有统计学意义(P<0.05)。各组不良反应的总比例分别为3、4、4、5例,各组比较,差异无统计学意义(χ~2=0.582,P>0.05)。结论 对剖宫产术产妇应用超声引导下不同容量TAP阻滞联合静脉镇痛,能够显著缓解镇痛作用、改善舒适度,0.25%罗哌卡因30 mL阻滞为最佳容量,且较安全。

Objective To apply ultrasound guidance of different volumes of ropivacaine transverse abdominal muscle plane(TAP) block combined with intravenous analgesia to women undergoing cesarean delivery,to analyze the analgesic effects and adverse reactions,and to explore the optimal volume.Methods A total of 120 women with cesarean section admitted to the First Affiliated Hospital of Kunming Medical University from January to December 2022 were selected as the research objects,and were randomly divided into control group,Group A,Group B and group C according to random number table method,with 30 cases in each group.The control group was pure intravenous analgesia group.Groups A,B and C were treated with 0.25% ropivacaine 20,25 and 30 mL block on each lateral transverse muscle plane,respectively.Pain,comfort,and sedation were evaluated at 2,6,12,24,36,and 48 h after surgery.The time of the first analgesia pump,the total number of analgesia pump compressions 48 h after the operation,the number of analgesia pump compressions 24 and 48 h after the operation,the dosage of patient controlled intravenous analgesia(PCIA) and the incidence of adverse reactions were recorded.Results Visual Analogue Scale(VAS) scores of group C at 36 and 48 h after surgery were lower than those of group A,48 h after surgery VAS scores of group C was lower than that of group B,and the differences were statistically significant(P<0.05).At 24,36 and 48 h after operation,the Bruggrmann Comfort Scale(BCS) and Ramsay score in group C were higher than those in control group,and the differences were statistically significant(P<0.05).At 36 and 48 h after surgery,BCS score and Ramsay score in group C were higher than those in group A,and the differences were statistically significant(P<0.05).48 h after surgery,BCS score and Ramsay score in group C were higher than those in group B,and the differences were statistically significant(P<0.05).The number of analgesic pump compression 24 h after surgery,the number of analgesic pump compression 48 h after surgery,the amount of PCIA 24 h after surgery,and the amount of PCIA 48 h after surgery showed a decreased trend,and the differences were statistically significant(P<0.05).The total proportion of adverse reactions among all groups was 3,4,4 and 5,respectively,and there was no statistically significant difference among all groups(χ~2=0.582,P>0.05).Conclusion TAP block with different volume guided by ultrasound combined with intravenous analgesia can significantly relieve analgesia and improve comfort.0.25% ropivacaine 30 mL block is the best volume,and it is relatively safe.