Görkem Ümit, Koçyiğit Kamuran, Toğrul Cihan, Güngör Tayfun
Department of Obstetrics and Gynecology, Hitit University Faculty of Medicine, Çorum, Turkey.
Department of Anesthesiology, Hitit University Training and Research Hospital, Çorum, Turkey.
J Turk Ger Gynecol Assoc. 2017 Mar 15;18(1):26-32. doi: 10.4274/jtgga.2016.0155.
The study aimed to compare efficacy, safety, pain intensity and analgesic consumption in patients receiving either bilateral transversus abdominis plane (TAP) block or wound infiltration with bupivacaine after cesarean delivery (CD).
A total of 216 parturient women undergoing CD under general anesthesia were randomly allocated into five groups: i) controls (group 1), ii) TAP placebo (group 2), iii) TAP (group 3), iv) wound infiltration placebo (group 4), and, v) wound infiltration (group 5). Pain intensity was assessed using a visual analogue scale (VAS). Analgesic consumptions were recorded by a blinded nurse at 6, 12, and 18 hours postoperatively.
The baseline characteristics of the five groups were similar in terms of age, history of CD, and body mass indices (p>0.05). There were significant intergroup differences in VAS scores between all groups at the zero time-point (p=0.03), at the 6th hour (p=0.02), 12th hour (p=0.02), and at the 18th hour (p=0.02). Group 3 patients had lower pain scores and consumed less diclofenac than group 2 patients only within 12 hours postoperatively whereas pain intensity and analgesic consumption were not different between group 5 and group 4 patients. Group 5 patients received significantly less pethidine than group 4 and group 1 patients (p<0.001).
TAP block provided better pain relief and less analgesic requirement than bupivacaine wound infiltration early after CD. Given the similar amounts of diclofenac but lower amounts of pethidine administered in the wound infiltration group, wound infiltration of bupivacaine seems promising in terms of reducing opioid use after CD under general anesthesia, especially when TAP block is not used.
本研究旨在比较剖宫产术后接受双侧腹横肌平面（TAP）阻滞或布比卡因伤口浸润的患者的疗效、安全性、疼痛强度和镇痛药消耗量。
总共216例在全身麻醉下接受剖宫产的产妇被随机分为五组：i）对照组（第1组），ii）TAP安慰剂组（第2组），iii）TAP阻滞组（第3组），iv）伤口浸润安慰剂组（第4组），以及v）伤口浸润组（第5组）。使用视觉模拟评分法（VAS）评估疼痛强度。术后6小时、12小时和18小时由一名不知情的护士记录镇痛药消耗量。
五组患者在年龄、剖宫产史和体重指数方面的基线特征相似（p>0.05）。在0时间点（p=0.03）、第6小时（p=0.02）、第12小时（p=0.02）和第18小时（p=0.02），所有组之间的VAS评分存在显著的组间差异。仅在术后12小时内，第3组患者的疼痛评分低于第2组患者，且双氯芬酸消耗量少于第2组患者，而第5组和第4组患者之间的疼痛强度和镇痛药消耗量无差异。第5组患者接受的哌替啶明显少于第4组和第1组患者（p<0.001）。
剖宫产术后早期，TAP阻滞比布比卡因伤口浸润提供更好的疼痛缓解且镇痛药需求量更少。鉴于伤口浸润组使用的双氯芬酸量相似但哌替啶量更少，布比卡因伤口浸润在减少全身麻醉下剖宫产术后阿片类药物使用方面似乎很有前景，尤其是在未使用TAP阻滞时。
