吗啡联合布比卡因腹横肌平面阻滞在腹式全子宫切除术术后镇痛中的应用和讨论

目的探讨吗啡联合布比卡因腹横肌平面阻滞(TAPB)在腹式全子宫切除术术后镇痛中的应用效果。方法本研究采用前瞻性方法,选取拟行腹式全子宫切除术患者94例,分成对照组和观察组,每组47例。患者全身麻醉后手术开始前15分钟左右行TAPB,对照组患者TAPB麻醉药物为0.5%盐酸布比卡因20 mL+生理盐水20 mL,共40 mL,观察组患者TAPB麻醉药物为0.5%盐酸布比卡因20 mL+吗啡10 mg+生理盐水20 mL,共40 mL。双侧TAPB分别注入20 mL麻醉药物混合液。结果观察组患者术后2、4、8、12、18和24 h静息疼痛评分和活动疼痛评分均显著低于对照组患者(P0.05)。观察组患者术后24 h内需要使用吗啡静脉患者自控镇痛(IV-PCA)的人数和吗啡IV-PCA总使用量均显著低于对照组患者(P0.05)。观察组患者术后首次使用吗啡IV-PCA时间显著高于对照组患者(P0.05)。观察组术后恶心和呕吐的发生率显著低于对照组患者(P0.05)。结论吗啡联合布比卡因TAPB较单纯布比卡因TAPB可显著降低腹式全子宫切除术术后患者24 h内疼痛评分、阿片类药物用量及其不良反应发生率,延长术后首次需要镇痛时间。

Analgesic effect of morphine added to bupivacaine in transversus abdominis plane block for total abdominal hysterectomy

Objective To investigate the analgesic effect of morphine added to bupivacaine in transversus abdominis plane block（TAPB）for total abdominal hysterectomy. Methods This is a prospective study where 94 patients prepared to received total abdominal hysterectomy were assigned to the control group and the observation group（n=47）. After general anesthesia patients received TAPB about 15 min before surgery. TAPB anaesthetics in the control group were 0.5% bupivacaine hydrochloride 20 ml plus normal saline 20 ml，and those in the observation group were 0.5% bupivacaine hydrochloride 20 ml plus morphine 10 mg and normal saline 20 mL. TAPB anaesthetics 20 ml were respectively injected in bilateral sides. Results Visual analog pain scale at rest and during movement at 2，4，8，12，18 and 24 h postoperatively was significantly lower in the observation group than that in the control group （P< 0.05）. Moreover，ratio of using morphine intravenous patientcontrolled analgesia（IV PCA）and morphine IV?PCA consumption at 24 h were significantly less in the observation group than that in the control group（P<0.05）. Time for first request of analgesia was significantly longer in the observation group than that in the control group（P<0.05）. Ratio of postoperative nausea and vomiting was significantly lower in the observation group than that in the control group（P<0.05）. Conclusion Morphine added to bupivacaine TAPB could significantly decrease visual analog pain scale，morphine consumption and ratio of adverse effect and prolong the time for first request of analgesia at 24 h postoperatively for total abdominal hysterectomy patients，which is worth popularizing clinically.