超声引导下罗哌卡因腰方肌与腹横肌平面阻滞在剖宫产术后镇痛效果比较

Postoperative analgesic effect comparison of ultrasound-guided ropivacaine quadratus lumborum block or transversus abdominis plane block during cesarean section of puerperae

目的:探究超声引导下罗哌卡因腰方肌与腹横肌平面阻滞在剖宫产术后镇痛效果。方法:选取2023年1-7月本院就诊的142例行剖宫产产妇,依据麻醉方式分为腰方肌组(QLB组)与腹横肌平面阻滞组(TAPB组)各71例,均在腰硬联合麻醉后行剖宫产术,在超声引导下QLB组在腰方肌注射罗哌卡因,TAPB组在腹内斜肌与腹横肌间注射。对比两组术后不同4、8、12、24、48h镇痛效果(VAS评分)、舒适度(舒适度评分),临床活动情况、术后2d镇静剂消耗量,术后不良反应发生率。结果:术后4h、8h两组VAS、舒适度评分无差异(P>0.05),术后12h、24h、48h QLB组VAS评分(2.25±0.33分、2.05±0.52分、1.82±0.34分)低于TAPB组(2.42±0.40分、2.23±0.43分、1.93±0.30分),舒适度评分(2.29±0.23、2.52±0.22、2.76±0.32)均高于TAPB组(2.16±0.30分、2.30±0.29分、2.51±0.30分)(均P<0.05)。两组首次坐起时间、进食时间无差异(P>0.05),QLB组首次站立时间(5.34±1.26h)、行走时间均(7.42±1.71h)短于TAPB组(6.25±1.35h、9.06±2.30h),镇静剂消耗量(38.50±5.63μg)少于TAPB组(77.23±7.85μg),不良反应发生率(11.3%)低于TAPB组(25.4%)(均P<0.05)。结论:QLB与TAPB均能为剖宫产产妇提供有效的术后镇痛效果,但QLB在镇痛时间、效果以及减少不良反应方面优势更明显。

Objective:To explore the postoperative analgesic effect comparison of ultrasound-guided ropivacaine quadratus lumborum block(QLB)or transversus abdominis plane block(TAPB)during cesarean section of puerperae.Methods:142 puerperae who wanted cesarean section were selected and were divided into two groups(71 cases in each group)according to the different anesthesia methods from January 2023 to July 2023.The puerperae in the two groups were all given spinal-epidural anesthesia during cesarean section.The puerperae in group A were injected with ropivacaine into quadratus lumborum and the puerperae in group B were injected with ropivacaine between obliquus internus abdominis and transversus abdominis.The analgesic effect evaluated by VAS score,the comfort evaluated by comfort score,the clinical activities situation at different time points(at postoperative 4,8,12,24 and 48 h),the consumption of sedatives in 2d after surgery and the incidence rates of postoperative adverse reaction of the puerperae were compared between the two groups.Results:There was no significant difference in the scores of VAS and comfort of the puerperae at postoperative 4h and 8h between the two groups(P>0.05).The VAS scores of the puerperae in group A at postoperative 12h,24h and 48h(2.25±0.33 points,2.05±0.52 points and 1.82±0.34 points)were significantly lower than those(2.42±0.40 points,2.23±0.43 points and 1.93±0.30 points)of the puerperae in group B.The comfort scores of the puerperae in group A at postoperative 12h,24h and 48h(2.29±0.23 points,2.52±0.22 points and 2.76±0.32 points)were significantly higher than those(2.16±0.30 points,2.30±0.29 points and 2.51±0.30 points)of the puerperae in group B(all P<0.05).There was no significant difference in the first sitting time and eating time of the puerperae between the two groups(P>0.05).The first standing time(5.34±1.26h)and the walking time(7.42±1.71h)of the puerperae in group A were significantly shorter than those(6.25±1.35h and 9.06±2.30h)of the puerperae in group B.The consumption of sedatives(38.50±5.63μg)of the puerperae in group A was significantly less than that(77.23±7.85μg)of the puerperae in group B,and the incidence of adverse reactions(11.3%)of the puerperae in group A was significantly lower than that(25.4%)of the puerperae in group B(all P<0.05).Conclusion:Both ropivacaine QLB and ropivacaine TAPB during cesarean section of the puerperae can provide their effective postoperative analgesia.The ropivacaine QLB has more obvious advantages in the analgesia time and effect,and the reduction of adverse reactions of the puerperae.