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超声引导腹横肌平面阻滞用于全麻剖宫产术术后镇痛的效果研究
Efficacy of Ultrasound-guided transversus abdominis plane block for postoperative analgesia in cesarean delivery under general anesthesia
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DOI:
作者:
刘林, 徐文平,肖飞,张引法
刘林? 徐文平 肖飞 张引法
作者单位:
浙江省嘉兴市妇幼保健院
Jiaxing Maternity and Child Health Care Hospital
关键词:
腹横肌平面阻滞; 术后镇痛; 剖宫产;全麻
Transversus abdominis plane block, postoperative analgesia, caesarean delivery, general anesthesia
摘要:
【摘要】 目的 观察超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于全麻剖宫产术患者术后镇痛的效果。方法 择期拟在全身麻醉下行子宫下段剖宫产术患者40例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=20):罗哌卡因组(Ⅰ组)和等量生理盐水组(Ⅱ组)。手术结束后在超声引导下行双侧TAP阻滞,每侧分别注射0.375%罗哌卡因20ml(Ⅰ组)或等容量0.9%氯化钠溶液(Ⅱ组)。术毕所有患者均行患者静脉自控镇痛(PCIA)。比较两组术后2、6、12、24h和48h视觉模拟疼痛(VAS)评分,记录术后镇痛泵第一次按压时间、24h镇痛泵按压次数、镇痛满意度、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、6 、12和24h的VAS评分降低(P<0.05)。与Ⅱ组相比,Ⅰ组术后镇痛泵第一次按压时间明显延迟(P<0.05),24h镇痛泵按压次数减少(P<0.01),镇痛满意度更好(P<0.05),术后24h内PCIA量明显减少(P<0.01)。两组均未见与TAP穿刺相关的并发症。 结论 超声引导下TAP阻滞用于全麻剖宫产术患者的术后镇痛效果好,患者镇痛满意度高,PCIA的需要量更少。
【Abstract】 Objective To observe the efficacy of Ultrasound-guided transversus abdominis plane(TAP) block for postoperative analgesia in elective cesarean delivery under general anesthesia. Medthods Forty ASAⅠ-Ⅱ patients scheduled for elective caesarean delivery under general anesthesia were randomly divided into 2 groups(n=20 each) by a random number table:ropivacaine group(groupⅠ) and same volume saline group(groupⅡ).The ultrasound-guided bilateral TAP block was performed at the end of surgety,and 0.375% ropivacaine 20 ml was injected each side in group Ⅰ ,while the equal voume of normal saline was given in groupⅡ .The patients received PCIA. We studied the pain on a visual analogue scale(VAS)scores at 2、6、12、 24 and 48h, the time to require the first bolus, and the numbers of bolus in 24h.The satisfaction on analgesia and total consumption of PCIA within 24h after operation were also recored.The adverse reactions were also recored. Results Compared with groupⅡ,VAS scores were significantly decreased at 2,6,12 and 24 h after operation in groupⅠ(P<0.05). Compared with groupⅡ, the time to require the first bolus was significantly longer, compression numbers were less , the satisfaction on analgesia were better in groupⅠ(P<0.05),and the consumption of PCIA within 24 h were significantly lower(P<0.01). TAP block-related complications were not found in both groups. Conclusion The efficacy of Ultrasound-guided TAP block for postoperative analgesia is better in elective caesarean delivery under general anesthesia , the satisfaction on analgesia were better and the requirement of analgesics during PCIA is lower.
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