Canakci Ebru, Gultekin Ahmet, Cebeci Zubeyir, Hanedan Bulent, Kilinc Anil
Ordu University, School of Medicine, Training and Research Hospital, Department of Anesthesia and Reanimation, Ordu, Turkey.
Golkoy State Hospital, Golkoy, Ordu, Turkey.
Pain Res Manag. 2018 Oct 17;2018:3562701. doi: 10.1155/2018/3562701. eCollection 2018.
TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques.
Eighty patients in the ASA I-II risk group, undergone an elective C-section, were randomly assigned to the study. In the TAP group, before the C-section, a single-dose spinal anaesthesia was performed by administering 3 ml of 0.5% hyperbaric bupivacaine to the patients when they were in the sitting position. After the C-section, an ultrasound-guided bilateral TAP block was performed in these patients in the recovery room for postoperative analgesia. In the single-dose EPI group, the patients received 16 cc of isobaric bupivacaine, 3 mg of morphine, and 50 mcg of fentanyl, making a total volume of 20 cc and being administered to the epidural space.
A higher level of patient satisfaction was observed in the EPI group (=0.003). The amount (mg) of total analgesics received by the patients in the first 24 hours of the postoperative period was statistically significantly higher (=0.021) in the TAP group compared to the EPI group. The visual analogue scale (VAS) scores of the EPI group were significantly lower compared to that of the TAP group ( < 0.001).
The epidural anaesthesia is still the golden standard to achieve a postcaesarean analgesia. Epidural anaesthesia is a considerably effective method in controlling the postoperative pain. We are of the opinion that epidural anaesthesia should be preferred in the first place to achieve a successful postcaesarean analgesia as it provides more effective pain control.
腹横肌平面（TAP）阻滞已广泛应用于腹部手术后的镇痛，但与硬膜外镇痛相比其优势存在争议。对于下腹部手术，硬膜外镇痛一直是提供术后镇痛的金标准且久经考验，但硬膜外镇痛的禁忌证使得需要其他同样有效的镇痛技术。本研究的目的是比较这两种技术的镇痛效果。
80例美国麻醉医师协会（ASA）I-II级风险组且接受择期剖宫产的患者被随机分配至本研究。在TAP组，剖宫产术前，患者处于坐位时给予3毫升0.5%的重比重布比卡因进行单次脊麻。剖宫产后，在恢复室对这些患者进行超声引导下双侧TAP阻滞用于术后镇痛。在单次剂量硬膜外组，患者接受16毫升等比重布比卡因、3毫克吗啡和50微克芬太尼，总量20毫升，注入硬膜外腔。
硬膜外组患者满意度更高（P=0.003）。术后24小时内TAP组患者接受的总镇痛药剂量（毫克）与硬膜外组相比在统计学上显著更高（P=0.021）。硬膜外组的视觉模拟评分（VAS）显著低于TAP组（P<0.001）。
硬膜外麻醉仍是剖宫产术后镇痛的金标准。硬膜外麻醉是控制术后疼痛相当有效的方法。我们认为，硬膜外麻醉应首先被选用以成功实现剖宫产术后镇痛，因为它能提供更有效的疼痛控制。
