Cüneyitoğlu Şule, Türktan Mediha, Biricik Ebru, Özcengiz Dilek
Clinic of Anaesthesiology and Reanimation, Aşkım Tüfekçi State Hospital, Adana, Turkey.
Department of Anaesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey.
Turk J Anaesthesiol Reanim. 2015 Oct;43(5):318-22. doi: 10.5152/TJAR.2015.79037. Epub 2015 Aug 21.
This study aimed to evaluate the effects of ultrasound-guided rectus sheath block in gynaecological surgery with Pfannenstiel incision.
After the approval of the ethics committee and the patients' consent, 75 ASA I-II patients who were aged between 20 and 70 years and scheduled for a gynaecological surgery with Pfannenstiel incision were included in this study. After induction of general anaesthesia, patients were randomly divided into three groups. In Group UR patients (n=25), ultrasound-guided rectus sheath block with 0.25% levobupivacaine (0.2 mL kg(-1)) was performed. In Group SR patients (n=25), surgical rectus sheath block with 0.25% levobupivacaine (0.2 mL kg(-1)) was applied. In Group T (n=25) patients, tramadol (2 mg kg(-1)) was intravenously administered 30 min before the end of surgery. Patient-controlled analgesia device was established for postoperative pain relief in all groups. Haemodynamic data and inspired sevoflurane concentration were recorded during the operation. Pain scores, total tramadol consumption, supplemental analgesic requirement and side effects were postoperatively evaluated.
Demographic characteristics, duration of surgery and haemodynamic parameters were similar between the groups. Inspired sevoflurane concentration (%) and VAS scores were significantly lower in Group UR than those in Groups SR and T. Total tramadol consumption was significantly lower in Groups UR and SR than that in Group T. There was no significant difference in the incidence of side effects.
This study demonstrates that ultrasound-guided rectus sheath block helps to provide the effective analgesia without any side effects compared with surgical rectus sheath block and intravenous tramadol for gynaecological surgery with Pfannenstiel incision.
本研究旨在评估超声引导下腹直肌鞘阻滞在耻骨联合上横切口妇科手术中的效果。
经伦理委员会批准并获得患者同意后，本研究纳入了75例年龄在20至70岁之间、计划行耻骨联合上横切口妇科手术的美国麻醉医师协会（ASA）I-II级患者。全身麻醉诱导后，患者被随机分为三组。UR组（n = 25）患者接受超声引导下0.25%左旋布比卡因（0.2 mL·kg⁻¹）腹直肌鞘阻滞。SR组（n = 25）患者接受手术直视下0.25%左旋布比卡因（0.2 mL·kg⁻¹）腹直肌鞘阻滞。T组（n = 25）患者在手术结束前30分钟静脉注射曲马多（2 mg·kg⁻¹）。所有组均使用患者自控镇痛装置进行术后镇痛。记录术中血流动力学数据和吸入七氟醚浓度。术后评估疼痛评分、曲马多总用量、补充镇痛药物需求及副作用。
三组患者的人口统计学特征、手术时间和血流动力学参数相似。UR组的吸入七氟醚浓度（%）和视觉模拟评分（VAS）均显著低于SR组和T组。UR组和SR组的曲马多总用量均显著低于T组。副作用发生率无显著差异。
本研究表明，对于耻骨联合上横切口妇科手术，与手术直视下腹直肌鞘阻滞和静脉注射曲马多相比，超声引导下腹直肌鞘阻滞有助于提供有效的镇痛且无任何副作用。
