Fusco P, Scimia P, Paladini G, Fiorenzi M, Petrucci E, Pozone T, Vacca F, Behr A, Micaglio M, Danelli G, Cofini V, Necozione S, Carta G, Petrini F, Marinangeli F
Unità Operativa Complessa di Anestesia e Rianimazione, Ospedale S. Salvatore, L'Aquila, Italia -
Minerva Anestesiol. 2015 Feb;81(2):195-204. Epub 2014 Apr 16.
Cesarean delivery is a major surgical procedure, after which a woman can experience substantial postoperative discomfort or pain. Inadequate postoperative analgesia is one of the most common reasons for poor patient satisfaction following cesarean delivery. Although spinal or systemic opioids are currently the gold standard to achieve effective analgesia, they are often associated with side effects. In the last few years there has been growing interest in abdominal plane blocks, with promising data on their efficacy. The transversus abdominis plane (TAP) block is a regional analgesic technique which is gaining acceptance in postoperative analgesia for lower abdominal surgeries. In this systematic review of articles published as of 31 December 2013, we searched the principal medical databases for randomized controlled trials that assessed the efficacy of ultrasound (US)-guided TAP block following cesarean delivery and reported on postoperative opioid consumption and pain score, opioid-related side-effects and patient satisfaction. Although controversy surrounds the utility of US-guided TAP block in cesarean section, evidence suggests that when correctly executed as part of a multimodal analgesic regimen, TAP block may reduce postoperative opioid consumption and opioid-related side effects, improving postoperative pain control and patient satisfaction. Further studies are necessary to explore this field of research.
剖宫产是一种大型外科手术，术后女性可能会经历严重的不适或疼痛。术后镇痛不足是剖宫产术后患者满意度低的最常见原因之一。尽管目前脊髓或全身性阿片类药物是实现有效镇痛的金标准，但它们常常伴有副作用。在过去几年中，人们对腹部平面阻滞的兴趣日益浓厚，有关其疗效的数据很有前景。腹横肌平面（TAP）阻滞是一种区域镇痛技术，在腹部以下手术的术后镇痛中越来越被认可。在对截至2013年12月31日发表的文章进行的这项系统评价中，我们在主要医学数据库中检索了评估剖宫产术后超声（US）引导下TAP阻滞疗效并报告术后阿片类药物消耗量、疼痛评分、阿片类药物相关副作用及患者满意度的随机对照试验。尽管US引导下TAP阻滞在剖宫产中的效用存在争议，但证据表明，如果作为多模式镇痛方案的一部分正确实施，TAP阻滞可能会减少术后阿片类药物消耗量及阿片类药物相关副作用，改善术后疼痛控制和患者满意度。有必要进行进一步研究以探索该研究领域。
