Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia.
Faculty of Medicine, University of Queensland, Herston, Australia.
Anaesthesia. 2018 May;73(5):594-602. doi: 10.1111/anae.14222. Epub 2018 Jan 29.
This study investigated the efficacy of a new ilioinguinal-transversus abdominis plane block when used as a component of multimodal analgesia. We conducted a prospective, triple-blind, placebo-controlled randomised study of 100 women undergoing elective caesarean section. All women had spinal anaesthesia with hyperbaric bupivacaine, 15 μg fentanyl and 150 μg morphine, as well as 100 mg diclofenac and 1.5 g paracetamol rectally. Women were randomly allocated to receive the ilioinguinal-transversus abdominis plane block or a sham block at the end of surgery. The primary outcome was the difference in fentanyl patient-controlled analgesia dose at 24 h. Secondary outcomes included postoperative pain scores, adverse effects and maternal satisfaction. The cumulative mean (95%CI) fentanyl dose at 24 h was 71.9 (55.6-92.7) μg in the ilioinguinal-transversus abdominis group compared with 179.1 (138.5-231.4) μg in the control group (p < 0.001). Visual analogue scale pain scores averaged across time-points were 1.9 (1.5-2.3) mm vs. 5.0 (4.3-5.9) mm (p = 0.006) at rest, and 4.7 (4.1-5.5) mm vs. 11.3 (9.9-13.0) mm (p = 0.001) on movement, respectively. Post-hoc analysis showed that the ilioinguinal-transversus abdominis group was less likely to use ≥ 1000 μg fentanyl compared with the control group (2% vs. 16%; p = 0.016). There were no differences in opioid-related side-effects or maternal satisfaction with analgesia. The addition of the ilioinguinal-transversus abdominis plane block provides superior analgesia to our usual multimodal analgesic regimen.
本研究旨在探究腹横肌平面（TAP）阻滞联合多模式镇痛在剖宫产术后的应用效果。我们进行了一项前瞻性、三盲、安慰剂对照的随机研究，共纳入 100 例行择期剖宫产的女性。所有患者均接受蛛网膜下腔阻滞麻醉，局麻药为布比卡因（15 μg）、芬太尼（150 μg）和吗啡（150 μg），同时给予直肠双氯芬酸钠（100 mg）和对乙酰氨基酚（1.5 g）。手术结束时，患者随机分为 TAP 阻滞组和假阻滞组。主要观察指标为术后 24 h 内患者芬太尼自控镇痛（PCA）的用量。次要观察指标包括术后疼痛评分、不良反应和产妇满意度。TAP 阻滞组术后 24 h 的累积芬太尼平均（95%CI）剂量为 71.9（55.6-92.7）μg，对照组为 179.1（138.5-231.4）μg（p < 0.001）。TAP 阻滞组在各时间点的平均（95%CI）静息状态下疼痛视觉模拟评分（VAS）为 1.9（1.5-2.3）mm，对照组为 5.0（4.3-5.9）mm（p = 0.006）；运动时 VAS 评分分别为 4.7（4.1-5.5）mm 和 11.3（9.9-13.0）mm（p = 0.001）。事后分析显示，TAP 阻滞组使用芬太尼≥1000 μg 的可能性明显低于对照组（2% vs. 16%；p = 0.016）。两组患者的阿片类药物相关不良反应发生率或镇痛满意度无差异。TAP 阻滞联合多模式镇痛可提供更优的镇痛效果。
