Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA.
Curr Pain Headache Rep. 2021 Mar 24;25(5):28. doi: 10.1007/s11916-021-00945-4.
In this review, we discuss surgical infiltration and various abdominal wall blocks, including transversus abdominis plane (TAP) block and quadratus lumborum blocks, and review the literature on the evidence behind these approaches and analgesia for cesarean delivery (CD).
Adequate pain management in the parturient following CD is important to facilitate early ambulation and neonatal care while also improving patient satisfaction and decreasing hospital length of stay. Neuraxial opioids have been a mainstay for postoperative analgesia; however, this option may not be available for patients undergoing emergency CD and have contraindications to neuraxial approaches, refusing an epidural or spinal, or with technical difficulties for neuraxial placement. In such cases, alternative options include a fascial plane block or surgical wound infiltration. The use of regional blocks or surgical wound infiltration is especially recommended in the parturient who does not receive neuraxial opioids for CD. Adequate postoperative analgesia following CD is an important component of the overall care of the parturient as it helps facilitate early mobilization and improve patient satisfaction. In conclusion, the use of abdominal fascial plane blocks or surgical wound infiltration is recommended in the parturient who does not receive neuraxial opioids for CD.
本文讨论了手术浸润和各种腹壁阻滞，包括腹横肌平面（TAP）阻滞和腰方肌阻滞，并回顾了这些方法背后的证据和剖宫产（CD）镇痛的文献。
CD 后产妇的充分疼痛管理对于促进早期活动和新生儿护理很重要，同时也可以提高患者满意度并缩短住院时间。椎管内阿片类药物一直是术后镇痛的主要方法；但是，对于接受紧急 CD 的患者，或者存在椎管内禁忌、拒绝硬膜外或脊髓麻醉、或者存在椎管内置管技术困难的患者，这种选择可能不可行。在这种情况下，替代方案包括筋膜平面阻滞或手术切口浸润。对于未接受 CD 椎管内阿片类药物的产妇，建议使用区域阻滞或手术切口浸润。CD 后充分的术后镇痛是产妇整体护理的重要组成部分，因为它有助于促进早期活动和提高患者满意度。总之，对于未接受 CD 椎管内阿片类药物的产妇，建议使用腹部筋膜平面阻滞或手术切口浸润。
