Urfalıoğlu Aykut, Bakacak Murat, Boran Ömer Faruk, Yazar Fatih Mehmet, Arslan Mahmut, Öksüz Hafize
Kahramanmaras Sutcu Imam University, School of Medicine, Department of Anesthesia and Reanimation, Kahramanmaras, Turquia.
Kahramanmaras Sutcu Imam University, School of Medicine, Department of Obstetrics and Gynecology, Kahramanmaras, Turquia.
Rev Bras Anestesiol. 2017 Sep-Oct;67(5):480-486. doi: 10.1016/j.bjan.2017.04.010. Epub 2017 May 16.
Ultrasound-guided transversus abdominis plane block demonstrated efficacy in providing post-operative analgesia by prolonging the time to first analgesic requirement and reducing the total analgesic consumption. The surgical transversus abdominis plane block, a novel technique, can be performed safely in obese patients in whom muscle layers cannot be sufficiently exposed. Here, we compared applicability, efficacy and complications of surgical transversus abdominis plane and ultrasound-guided transversus abdominis plane blocks in obese pregnant women following cesarean section under general anesthesia.
Seventy-five pregnant women with pre- and post-pregnancy body mass index>30 were randomized and allocated into two groups: Ultrasound-guided transversus abdominis plane block (UT group; n=38) and surgical TAP block (ST group; n=37). Visual analogue scale scores at post-operative 0, 2, 6, 12 and 24hours (h), time to first analgesic requirement, total analgesic consumption amount in 24h, post-operative side effects, complications and patient satisfaction were recorded.
Age, American Society of Anesthesiologist score, operative duration, body mass index, mean time to first analgesic requirement and total analgesic consumption in 24h were similar between groups, while significant differences in pre- and post-pregnancy body mass index were observed between groups. Block procedure durations were 7 and 10minutes in ST and UT groups, respectively. No significant differences in visual analogue scale scores were observed between the groups at all times; itching and nausea was observed in one (UT group) and four (UT and ST groups) patients, respectively. Surgical transversus abdominis plane block was safe in obese pregnant patients and provided similar post-operative analgesia to ultrasound-guided transversus abdominis plane block.
超声引导下腹横肌平面阻滞通过延长首次镇痛需求时间和减少总镇痛药物用量，在提供术后镇痛方面显示出疗效。外科腹横肌平面阻滞是一种新技术，可在肌肉层无法充分暴露的肥胖患者中安全实施。在此，我们比较了全麻下行剖宫产术后肥胖孕妇中，外科腹横肌平面阻滞与超声引导下腹横肌平面阻滞的适用性、疗效及并发症。
75例孕前及孕后体重指数>30的孕妇被随机分为两组：超声引导下腹横肌平面阻滞组（UT组；n = 38）和外科腹横肌平面阻滞组（ST组；n = 37）。记录术后0、2、6、12和24小时（h）的视觉模拟评分、首次镇痛需求时间、24小时内总镇痛药物用量、术后副作用、并发症及患者满意度。
两组间年龄、美国麻醉医师协会评分、手术时长、体重指数、首次镇痛需求平均时间及24小时内总镇痛药物用量相似，但两组间孕前及孕后体重指数存在显著差异。ST组和UT组的阻滞操作时间分别为7分钟和10分钟。两组在各时间点的视觉模拟评分均无显著差异；分别有1例（UT组）和4例（UT组和ST组）患者出现瘙痒和恶心。外科腹横肌平面阻滞在肥胖孕妇中是安全的，且提供了与超声引导下腹横肌平面阻滞相似的术后镇痛效果。
