Vilchis Rentería J S, Peng P W H, Forero M
Department of Obstetric Anaesthesia Hospital Materno Infantil de Alta Especialidad Guadalupe Nuevo León México.
Department of Anesthesiology and Pain Management University Health Network University of Toronto Canada.
Anaesth Rep. 2020 Nov 12;8(2):e12083. doi: 10.1002/anr3.12083. eCollection 2020 Jul-Dec.
The management of pain during labour is central to obstetric anaesthetic practice. While epidural analgesia has long been considered the gold standard for intrapartum analgesia, neuraxial techniques can be challenging to perform, are contra-indicated in circumstances such as coagulopathy. The erector spinae plane block is an interfascial plane block that has generated interest because of a needle tip position away from the neuraxis. This has the potential to mitigate the risks of nerve injury and epidural haematoma formation. The mechanism of action is linked to both paravertebral and epidural distribution of local anaesthetic, providing both somatic and visceral analgesia, with potential utility in obstetric settings. Four women in active labour received either unilateral or bilateral erector spinae plane blocks. All experienced a reduction in pain, ranging from 3 to 6 points measured on a 10-point numerical rating scale. The duration of analgesia ranged from 60 to 120 min. In this report, we discuss potential for using the erector spinae plane block in the management of obstetric pain.
分娩期间的疼痛管理是产科麻醉实践的核心。虽然长期以来硬膜外镇痛一直被视为产时镇痛的金标准，但神经轴技术实施起来可能具有挑战性，在诸如凝血功能障碍等情况下是禁忌的。竖脊肌平面阻滞是一种筋膜间平面阻滞，因其针尖位置远离神经轴而受到关注。这有可能降低神经损伤和硬膜外血肿形成的风险。其作用机制与局部麻醉药在椎旁和硬膜外的分布有关，可提供躯体和内脏镇痛，在产科环境中具有潜在应用价值。四名活跃期分娩的女性接受了单侧或双侧竖脊肌平面阻滞。所有人的疼痛均有减轻，在10分数字评分量表上的疼痛减轻范围为3至6分。镇痛持续时间为60至120分钟。在本报告中，我们讨论了使用竖脊肌平面阻滞管理产科疼痛的可能性。
