不同剂量罗哌卡因腹横肌平面阻滞在剖宫产术后镇痛中的疗效比较

目的 比较剖宫产术后不同剂量罗哌卡因在超声引导下行腹横肌平面阻滞（transversus abdominal plane,TAP）镇痛中的疗效.方法 实施单次腰麻下剖宫产单胎足月孕初产妇60例,计算机排序随机分为A组（0.5％罗哌卡因3 mg/kg）、B组（0.5％罗哌卡因1.5mg/kg）和C组（对照组）各20例.在手术结束后实施超声引导下TAP.观察48小时内各随访时点的疼痛评分（numerical rating scale,NRS）和产妇满意度评分.48小时内辅助镇痛药使用频率.结果 产妇在术后6及12小时时点NRS运动时评分,A组明显低于B组和C组（P＜0.05）,余时点未见统计学差异（P＞0.05）;NRS静息时评分各时点组间比较皆无差异（P＞0.05）.各组产妇满意度评分无差异（P＞0.05）.72小时内辅助镇痛药使用率各组间无差异（P＞0.05）.结论 超声引导下单次0.5％罗哌卡因3 mg/kg剂量腹横肌平面阻滞可以产生良好的12小时左右的产科术后镇痛,但更长时间的持续镇痛需要改进操作方法.

Comparison of two doses of ropivacaine in postoperative pain control by ultrasound-guided transversus abdominis plane blocks for post-cesarean delivery analgesia

Objective To compared the analgesic efficacy of two doses of local anesthetic ropivacaine for TAP （transversus abdominal plane） blocks after cesarean delivery （CD）. Methods Each of the 20 cases of sixty women hav- ing CD under spinal anesthesia were randomized to receive ultrasound-guided TAP blocks using 0.5% 3 mg/kg dose ropi- vacaine （A group）, 1.5 mg/kg ropivacaine （B group） or placebo（C group）. After CD procedure, the three groups of pa- tients received TAP. Quality of the patients＇ pain was evaluated by NRS （numerical rating scale） at rest and movement, and maternal satisfaction score, still using the NRS. The demographic data and and incidence of using medications after CD in 72h were recorded in all groups. Results Postoperative 6 h and 14 h time points in A group, NRS movement scores were significantly lower than the B and C group （P〈0.05）, but there was no difference between groups in other time points（P〉0.05）. All the NRS scores at rest were similar between groups（P〉0.05）. The maternal satisfaction and medications used in 72h after CS in three groups had no difference （P〉0. 05）. Conclusion 0. 5 % 3 mg/kg dose ropiva- caine TAP blocks may improve pain scores up to 12 h after cesarean delivery, but continuous longer time analgesia maybe need to improve methods of operation.