超声引导下腹横肌平面阻滞在疤痕子宫产妇剖宫产术后镇痛中的效果

目的 观察超声引导下腹横肌平面阻滞(TAPB)在疤痕子宫产妇剖宫产术后镇痛中的效果.方法 选择择期剖宫产的疤痕子宫经产妇84例,年龄20～45岁,体重60～80 kg,BMI≤30 kg/m2,ASAⅡ级,孕期37～42周.将产妇随机分为两组:布托啡诺PCIA组(P组)和布托啡诺PCIA联合TAPB组(PT组),每组4...

Effect of ultrasound-guided transversus abdominis plane block on postoperative maternal analgesia after repeated cesarean section

Objective To observe the effect of ultrasound-guided transversus abdominis plane block(TAPB)on postoperative maternal analgesia after repeated cesarean section.Methods Eighty-four multipara with scarred uterus undergoing second cesarean section,aged 20-45 years,weighing 60-80 kg,BMI≤30 kg/m²,and 37-42 gestational weeks,ASA physical statusⅡ,were randomly divided into two groups:butorphanol patient-controlled intravenous analgesia(PCIA)group(group P)and butorphanol PCIA combined with TAPB group(group PT),42 multiparas in each group.Both groups received combined lumbar and epidural anesthesia.Both groups were given butorphanol PCIA after surgery,on top of which group PT was given TAPB guided by ultrasound.When postoperative VAS pain score≥4 scores,butorphanol 1 mg was added intravenously.The dosage of butorphanol in analgesic pump was recorded at 0-6 hours,6-12 hours,12-18 hours,and 18-24 hours postoperatively.The first pressing time of analgesic pump,the effective pressing times of analgesic pump and the number of remedial analgesia were recorded.Venous blood was collected before and 6 hours after operation to detect serum substance P concentration.Satisfactory cases of analgesia and the incidence of opioid-related adverse reactions such as nausea,vomiting and dizziness were recorded 24 hours after operation.Results Compared with group P,the pressing times of analgesic pump and the dosage of butorphanol in analgesic pump were significantly reduced in group PT at 0-6 hours after operation(P<0.05),the incidence of remedial analgesia was also significantly reduced and the time of first pressing of analgesic pump was significantly delayed in group PT(P<0.05).Compared with that before operation,the serum concentration of substance P in the two groups was significantly increased 6 hours after operation(P<0.05).There was no significant difference in the rate of analgesia satisfaction and the incidence of adverse reactions between the two groups 24 hours after operation.Conclusion Ultrasound-guided TAPB combined with butorphanol PCIA can effectively alleviates postoperative pain and reduces the consumption of butorphanol in the first 6 hours,which could be one of the multimodal analgesia methods for postoperative analgesia in multiparas undergoing repeated cesarean section.