Kupiec Anna, Zwierzchowski Jacek, Kowal-Janicka Joanna, Goździk Waldemar, Fuchs Tomasz, Pomorski Michał, Zimmer Mariusz, Kübler Andrzej
Katedra i Klinika Anestezjologii i Intensywnej Terapii, ul. Borowska 213, 50-556 Wrocław, Poland.
Ginekol Pol. 2018;89(8):421-424. doi: 10.5603/GP.a2018.0072.
The ultrasound-guided transversus abdominis plane (TAP) block is a supporting method of pain relief after different types of surgical and gynecological procedures. The aim of the present study was to evaluate the analgesic effects of the TAP-block in patients undergoing caesarean section.
88 women undergoing elective caesarean section under spinal anaesthesia were prospectively randomized into two groups. In the first group, an ultrasound-guided bilateral TAP block was performed using 40 mL 0.25% bupivacaine, while the second group was treated without a regional nerve block. Both groups received a standard analgesia protocol with intravenous paracetamol administered every 6 hours and intravenous tramadol on-demand, delivered using the Patient Controlled Analgesia (PCA) method. Pain intensity was assessed according to the visual analogue scale (VAS) directly after the TAP block and at 3, 6 and 12 hours postoperatively. Any patient complaints and side-effects during the postoperative period were recorded.
The TAP block resulted in a significant reduction of pain intensity using the visual analogue scale after 3, 6 and 12 hours (p < 0.05) and a significant decrease in tramadol administration (p < 0.05) during the first 12 hours postoperatively. No significant differences in the heart rate and blood pressure were noted between groups (p > 0.05). There were no complications related to the TAP block.
The TAP block is a safe and effective adjunctive method of pain relief after caesarean delivery.
超声引导下腹横肌平面（TAP）阻滞是不同类型外科手术和妇科手术后疼痛缓解的一种辅助方法。本研究的目的是评估TAP阻滞对剖宫产患者的镇痛效果。
88例在脊麻下行择期剖宫产的妇女被前瞻性随机分为两组。第一组使用40毫升0.25%布比卡因进行超声引导下双侧TAP阻滞，而第二组未接受区域神经阻滞治疗。两组均接受标准镇痛方案，每6小时静脉注射对乙酰氨基酚，并根据患者自控镇痛（PCA）方法按需静脉注射曲马多。在TAP阻滞结束后以及术后3、6和12小时，根据视觉模拟量表（VAS）评估疼痛强度。记录术后期间任何患者的主诉和副作用。
TAP阻滞使术后3、6和12小时使用视觉模拟量表的疼痛强度显著降低（p<0.05），并且术后前12小时曲马多的使用量显著减少（p<0.05）。两组之间心率和血压无显著差异（p>0.05）。未出现与TAP阻滞相关的并发症。
TAP阻滞是剖宫产术后一种安全有效的辅助镇痛方法。
