Kerai Sukhyanti, Saxena Kirti Nath, Taneja Bharti
Department of Anaesthesiology, Rajiv Gandhi Super Speciality Hospital, New Delhi, India.
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.
Indian J Anaesth. 2017 Mar;61(3):200-214. doi: 10.4103/ija.IJA_313_16.
Adequate post-operative analgesia after caesarean section (CS) is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP) block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB) for post-caesarean analgesia. Administration of opioids still remains the gold standard for post-operative analgesia, but the associated troublesome side effects have led to the mandatory incorporation of non-opioid analgesics in post-CS analgesia regime. Among the non-opioid techniques, TAP block is the most investigated modality of the last decade. The analgesic efficacy of TAP block as a part of multimodal analgesia is established in post-CS cases where intrathecal morphine is not employed and in CS under general anaesthesia. Among non-steroidal anti-inflammatory drugs, COX-I inhibitors and intravenous paracetamol are found to be useful in post-operative analgesic regimen. The perioperative use of ketamine is found useful only in CS done under spinal anaesthesia; no benefit is seen where general anaesthesia is employed. Wound infiltration with local anaesthetics, systemic gabapentin and II-IH NB need further trials to assess their efficacy.
剖宫产术后充分镇痛至关重要，因为它会影响产妇独特的手术恢复需求。尽管近年来已引入用于剖宫产术后镇痛的更新的镇痛方式和药物，但文献综述表明，我们远未实现最佳术后镇痛的目标。我们对剖宫产术后镇痛方式的最新进展进行了系统综述。在对研究进行系统检索和质量评估后，我们总共纳入了51项随机对照试验，这些试验评估了阿片类药物、腹横肌平面（TAP）阻滞、伤口浸润/输注、氯胺酮、加巴喷丁和髂腹股沟-髂腹下神经阻滞（II-IH NB）在剖宫产术后镇痛中的作用。阿片类药物的给药仍然是术后镇痛的金标准，但相关的麻烦副作用已导致在剖宫产术后镇痛方案中强制加入非阿片类镇痛药。在非阿片类技术中，TAP阻滞是过去十年中研究最多的方式。在未使用鞘内吗啡的剖宫产病例以及全身麻醉下的剖宫产中，TAP阻滞作为多模式镇痛一部分的镇痛效果已得到证实。在非甾体类抗炎药中，COX-I抑制剂和静脉注射对乙酰氨基酚在术后镇痛方案中被发现是有用的。氯胺酮的围手术期使用仅在脊髓麻醉下进行的剖宫产中被发现有用；在采用全身麻醉的情况下未见益处。局部麻醉药伤口浸润、全身性加巴喷丁和II-IH NB需要进一步试验以评估其疗效。
