腹横肌平面阻滞联合静脉自控多模式镇痛用于子宫切除术术后镇痛的效果研究

目的 观察腹横肌平面（TAP）阻滞联合患者静脉自控（PCIA）多模式镇痛用于子宫切除术患者术后镇痛的效果.方法 择期拟在全麻下行经腹子宫切除术患者40例,ASAⅠ或Ⅱ级,采用随机数字表法分为多模式镇痛组（Ⅰ组）和PCIA组（Ⅱ组）,每组20例.手术结束后在超声引导下行双侧TAP阻滞,Ⅰ组每侧注射0.375％罗哌卡因20ml,Ⅱ组每侧注射等容量0 9％氯化钠溶液.术毕所有患者均行PCIA.比较两组患者术后2、4、8、12、24h视觉模拟疼痛（VAS）评分,记录术后24h镇痛泵按压次数、镇痛总体满意度评分、PCIA的用量.记录两组不良反应的发生情况.结果 与Ⅱ组相比,Ⅰ组术后2、4、8和12的VAS评分明显降低（P＜0.05）,镇痛泵按压次数减少（P＜0.01）,镇痛总体满意度评分升高（P＜0.01）,术后24h内PCIA量明显减少（P＜0.05）.两组患者均未见与TAP穿刺相关的并发症.两组患者恶心、呕吐、皮肤瘙痒、呼吸抑制及尿潴留等不良反应发生率比较差异无统计学意义（P＞0.05）.结论 TAP阻滞联合PCIA多模式镇痛用于子宫切除术患者的术后镇痛,能明显减少PCIA的需要量,增强了术后镇痛效应.

Transversus abdominis plane block combined with patient-controlled intravenous analgesia for postoperative analgesia in patients undergoing hysterectomy

Objective To evaluate the efficacy of transversus abdominis plane block （TAPB） combined with patient-controlled intravenous analgesia （PCIA） for postoperative analgesia in patients undergoing hysterectomy. Methods Forty ASA Ⅰ - Ⅰ patients scheduled for abdominal hysterectomy under general anesthesia were randomly divided into two groups with 20 in each. In group Ⅰ （TAPB combined with PCIA） the ultrasound-guided bilateral TAP block was performed at the end of surgery and 0.375% ropivacaine 20 ml was injected each side, while in group Ⅱ （PCIA group） the equal volume of normal saline was given; in addition, patients in both groups received PCIA after surgery. The VAS scores were recorded at 2, 4, 8, 12 and 24h after operation. Compression numbers, the overall satisfaction scores on analgesia and consumption of PCIA within 24h after operation were recorded; the adverse reactions were also recorded. Results Compared with group Ⅱ, VAS scores in group Ⅰ were significantly lower at 2, 4, 8 and 12 h after operation （P〈0.05）. Compared with group Ⅱ, compression numbers in group Ⅰ were less and the overall satisfaction scores on analgesia were higher （P〈0.01）, and the consumption of analgesics for PCIA within 24 h was significantly lower （P〈0.05）. No TAP block-related complications were found in both groups. There were no significant differences in incidence rates of nausea,vomiting,pruritus,respiratory depression and urine detention between two groups （P 〉0.05）. Conclusion Multimodal analgesia of TAP block combined with PCIA can reduce the requirement of analgesics during PCIA, and enhance the efficacy of postoperative analgesia in patients undergoing hysterectomy.