布托啡诺PCIA联合超声引导下弓状韧带上腰方肌阻滞对剖宫产术后镇痛的应用效果评价

Evaluation of the Application Effect of Butorphanol PCIA Combined with Ultrasound-guided Lumbar Quadratus Muscle Block on Postoperative Analgesia after Cesarean Section

目的分析布托啡诺静脉自控镇痛(PCIA)联合超声引导下弓状韧带上腰方肌阻滞(QLB-LSAL)在剖宫产术后镇痛中的应用效果。方法选取2022年12月至2023年10月期间于本院行剖宫产手术的患者60例,按照随机数字表法予以分组。对照组采用布托啡诺PCIA进行术后镇痛,在此基础上研究组联合超声引导下QLB-LSAL。针对两组术后首次按压镇痛泵时间、48 h布托啡诺消耗量、镇痛泵追加次数、术后不同时间段静息状态与运动状态的视觉模拟量表(VAS)评分、离床活动时间、泌乳时间、肛门恢复排气时间、布鲁格曼舒适度量表(BCS),以及镇痛相关不良反应情况予以比较。结果与对照组结果对比,研究组首次按压镇痛泵时间更长(P<0.05),术后48h布托啡诺消耗量、镇痛泵追加次数更低(P<0.05)。与对照组相比,研究组术后6h、12 h、24 h、48 h静息状态、运动状态时的VAS评分更低(P<0.05)。与对照组结果相比,研究组离床活动时间、泌乳时间、恢复肛门排气时间更短(P<0.05),BCS评分更高(P<0.05)。在镇痛不良反应发生率比较中,两组结果无明显差异(P>0.05)。结论布托啡诺PCIA联合超声引导下QLB-LSAL能够有效提高剖宫产术后镇痛效果,减少布托啡诺用量,保障产妇的舒适度,促进产后康复进程。

Objective To analyze the application effect of butorphanol intravenous patient-controlled analgesia(PCIA)combined with ultrasound-guided arcuate ligament upper lumbar quadratus muscle block(QLB-LSAL)on postoperative analgesia after cesarean section.Methods Sixty patients who underwent cesarean section surgery in our hospital from December 2022 to October 2023 were selected and they are grouped according to the random number table method.The control group received postoperative analgesia with butorphanol PCIA,and on this basis,the study group received QLB-LSAL blockade under ultrasound guidance.Compare the time of first press of the analgesic pump,48 hour consumption of butorphanol,number of pump additions,VAS scores of resting and moving states at different time periods after surgery,time of out of bed activity,lactation time,time to recover anal exhaust,BCS scores,and analgesic related adverse reactions between two groups.Results Compared with the control group,the first time of the analgesic pump was longer in the study group(P<0.05),and the consumption of butorphanol and the number of additional analgesic pump were lower 48 h after the operation(P<0.05).Compared with the control group,the VAS scores of the study group at 6 h,12 h,24 h and 48 h after surgery were lower at resting state and exercise state(P<0.05).Compared with the control group,the study group had shorter time to get out of bed,lactation time and recovery time of anal exhaust(P<0.05),and higher BCS score(P<0.05).There was no significant difference in the incidence of adverse analgesia between the two groups(P>0.05).Conclusions The combination of butorphanol PCIA and ultrasound-guided QLB-LSAL can effectively improve the analgesic effect after cesarean section,reduce the dosage of butorphanol,improve the comfort of parturients,and promote the postpartum recovery process.