B超引导下0.25%与0.15%罗哌卡因双侧腹横肌平面阻滞对剖宫产术后镇痛效果比较

Effective comparison of 0.25% and 0.15% ropivacaine used in the bilateral transversus abdominis plane block guided by B-ultrasound of the women for their analgesia after cesarean section

目的:探究B超引导下比较0.25%与0.15%罗哌卡因双侧腹横肌平面阻滞对剖宫产产妇的镇痛效果。方法:选取2020年9月-2023年9月本院拟行剖宫产产妇90例,随机分为两组各45例。分别行B超引导下0.15%(0.15%组)及0.25%(0.25%组)罗哌卡因双侧腹横肌平面阻滞,对比两组术后恢复、术后镇痛、不同时点动态和静态疼痛评分(VAS)、氧化应激指标皮质醇(COR)和C反应蛋白(CRP)水平及不良反应。结果:0.25%组自主排尿时间(17.23±2.26h)、首次下床时间(11.32±2.56h)、24 h按压镇痛泵次数(3.37±0.59次)和镇痛泵液用量(50.02±5.34)均少于0.15%组(25.37±1.83h、15.19±2.37 h、6.28±0.81次),有效镇痛(41.33±3.18h)及术后首次按压镇痛泵时间(13.37±3.50h)高于0.15%组(29.62±1.87h、6.38±2.08h);相较于术后1h,两组术后动态和静态12h、24h VAS评分均降低且0.25%组(4.22±0.26分、3.01±0.35分,3.15±0.21分、2.16±0.24分)低于0.15%组(5.37±0.24分、3.89±0.17分,3.62±0.19分、2.95±0.28分);术后12h两组COR、CRP水平均高于术前但0.25%组(643.47±20.49 nmol/L、18.79±2.74 mg/L)低于0.15%组(757.43±17.49 nmol/L、27.54±3.83 mg/L)(均P<0.05)。不良反应0.25%组(15.6%)与0.15%组(11.1%)无差异(P>0.05)。结论:剖宫产术应用B超引导下0.25%罗哌卡因双侧腹横肌平面阻滞,可提高镇痛效果,降低产妇术后应激反应,且未显著增加不良反应。

Objective:To compare the analgesia effectiveness of 0.25%and 0.15%ropivacaine used in the bilateral transversus abdominis plane block guided by B-ultrasound of the women after cesarean section.Methods:90 pregnant women who wanted cesarean section were selected and were randomly divided into group A(45 women with 0.15%ropivacaine for analgesia used in the bilateral transversus abdominis plane block)and group B(45 women with 0.25% ropivacaine for analgesia)from September 2020 to September 2023.The postoperative recovery situation,the postoperative analgesia,the dynamic and static pain scores of VAS,the levels of oxidative stress indexes,such as cortisol(COR)and C-reactive protein(CRP),and the adverse reactions rate of the women were compared between the two groups.Results:The spontaneous urination time(17.23±2.26h),the first ambulation time(11.32±2.56h),the number of pressing analgesic pump in 24 h(3.37±0.59 times)and the amount of analgesic pump fluid used(50.02±5.34)of the women in group B were significantly less than those(25.37±1.83h,15.19±2.37 and 6.28±0.81 times)of the women in group A.The effective analgesia time(41.33±3.18h)and the time of the first pressing analgesia pump after operation(13.37±3.50h)of the women in group B were significantly higher than those(29.62±1.87h and 6.38±2.08 h)of the women in group A.The VAS scores of the women in the two groups at dynamic and static 12h and 24h after operation were significantly lower than those at 1h after operation,and which(4.22±0.26 points and 3.01±0.35 points,and 3.15±0.21 points and 2.16±0.24 points)of the women in group B were significantly lower than those(5.37±0.24 points and 3.89±0.17 points,and 3.62±0.19 points and 2.95±0.28 points)of the women in group A.The levels of COR and CRP of the women in the two groups at 12h after operation were significantly higher than those before operation,but which(643.47±20.49 nmol/L and 18.79±2.74mg/L)of the women in group B were significantly lower than those(757.43±17.49 nmol/L and 27.54±3.83mg/L)of the women in group A(all P<0.05).There was no significant difference in the adverse reactions rate(15.6%vs.11.1%)of the women between the two groups(P>0.05).Conclusion:0.25% ropivacaine used in the bilateral transversus abdominis plane block guided by B-ultrasound of the women can significantly enhance their postoperative analgesic effect,reduce their postoperative stress reaction,and without the increase of the adverse reactions.