超声引导下腹横肌平面阻滞用于剖宫产患者超前镇痛的效果

目的 评价超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产患者超前镇痛的效果.方法 采用前瞻性、随机对照研究设计.择期行剖宫产患者90例,年龄20～39岁,体重50～80 kg,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为3组(每组30例):对照组(Ⅰ组)、术前TAP阻滞组(Ⅱ组)、术后TAP阻滞组(Ⅲ组).Ⅰ组不实施TAP阻滞,Ⅱ组和Ⅲ组分别于麻醉诱导前即刻和手术结束时即刻在超声引导下行双侧TAP阻滞.记录术后2、4、12、24 h和48 h时点3组产妇静息状态下的VAS评分,术后24 h内舒芬太尼累积消耗量、镇痛补救率、镇痛泵按压次数,术后24 h内副作用发生情况.结果 Ⅱ组患者术后2、4h和12 h VAS评分(2.3±0.4)、(2.4±0.4)、(2.2±0.4)分]与Ⅲ组(3.2±0.8)、(34±0.3)、(3.1±0.5)分]比较,明显降低(P＜0.05);Ⅱ组患者术后24 h内舒芬太尼累积消耗量、镇痛补救率及镇痛泵按压次数(40±5)μg、10％、(5.8±1.4)次]与Ⅲ组(53±7)μg、20％、(10.3±2.6)次]比较,明显降低(P＜0.05);Ⅱ组患者术后24h内恶心呕吐发生率与Ⅲ组比较,明显降低(P＜0.05). 结论 术前超声引导下TAP阻滞对剖宫产患者具有良好的超前镇痛效应,且安全性较高.

Efficacy of ultrasound-guided transversus abdominis plane block for preemptive analgesia in patients undergoing caesarean section

Objective To evaluate the efficacy of ultrasound-guided transverses abdominis plane (TAP) block for preemptive analgesia in patients undergoing caesarean section.Methods Ninety ASA physical status Ⅰ,Ⅱ patients,aged 20-39 y,weighed 50-80 kg,scheduled for cesarean section,were randomly divided into 3 groups (n=30) using a random number table:control group (group Ⅰ),preoperative TAP block group (group l]) and postoperative TAP block group (group Ⅲ).Bilateral transverses abdominis plane block was performed under the guidance of ultrasound immediately before induction of anesthesia and at the end of surgery in ]Ⅱ and]]Ⅲ groups,respectively.The VAS in each at 2,4,12,24,48 h after surgery with rest,the cumulative consumption of sufentanil within 24 h,the rate of rescue analgesia and times of pressing patient-controlled intravenous analgesia,the adverse reactions occurred after surgery were detected.Results The VAS scores of the patients in group Ⅱ at 2,4,12 h after surgery (2.3±0.4),(2.4±0.4),(2.2±0.4)] were significantly lower when compared with group Ⅲ (3.2±0.8),(3.4±0.3),(3.1±0.5)](P＜0.05).The cumulative consumption of sufentanil within 24 h,the rate of rescue analgesia and times of pressing patient-controlled intravenous analgesia of group Ⅱ (40±5) μg,10％,(5.8±1.4)] were significantly decreased when compared with group Ⅲ(53±7) μg,20％,(10.3±2.6)] (P＜0.05).The rate of nausea and vomiting in group Ⅱ within 24 h was significantly reduced when compared with group Ⅲ (P＜0.05).Conclusions Preoperative transverses abdominis plane block can provide good preemptive analgesia in the patients undergoing cesarean section.