硬膜外镇痛中导管-切口一致性对剖宫产术后疼痛管理的影响：一项单盲随机对照试验。

Influence of Catheter-Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial.

作者信息

Chen Ying-Hsi, Chou Wei-Han, Yie Jr-Chi, Teng Hsiao-Chun, Wu Yi-Luen, Wu Chun-Yu

机构信息

Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan.

Department of Medical Education, National Taiwan University, Taipei 100, Taiwan.

出版信息

J Pers Med. 2021 Oct 27;11(11):1099. doi: 10.3390/jpm11111099.

DOI:10.3390/jpm11111099

PMID:34834451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8619661/

Abstract

UNLABELLED

Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter-incision incongruent for cesarean delivery.

METHODS

In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of >33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated.

RESULTS

The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; < 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade ( = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups ( < 0.001).

CONCLUSIONS

Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.

摘要

未标注

患者自控硬膜外镇痛（PCEA）或硬膜外吗啡可减轻剖宫产术后疼痛；然而，传统的腰椎硬膜外穿刺置管用于剖宫产时，导管与手术切口不一致。

方法

总共189例行剖宫产的妇女被随机分为四组（胸段低位PCEA组、腰椎PCEA组、胸段低位吗啡组和腰椎吗啡组）进行剖宫产术后疼痛管理。使用100毫米视觉模拟评分法（VAS）测量疼痛强度，包括静息痛、动态痛和子宫收缩痛。将VAS评分>33毫米的经历动态伤口疼痛的参与者比例作为主要结局进行评估。评估不良反应，包括下肢阻滞、瘙痒、术后恶心呕吐、镇静以及首次排气时间。

结果

在脊麻后6小时，胸段低位PCEA组报告动态疼痛的参与者比例最低（胸段低位PCEA组为28.8%；腰椎PCEA组为69.4%；胸段低位吗啡组为67.3%；腰椎吗啡组为73.9%；P<0.001）。上述组在术后24小时内静息、动态和子宫收缩痛的VAS评分也最有利。四组之间的不良反应情况相似，但腰椎PCEA组中报告术后下肢运动阻滞延长的参与者比例更高（比其他三组约高20%；P=0.005）。此外，胸段低位PCEA组术后首次排气时间比两个吗啡组早约8小时（P<0.001）。