Jemal Bedru, Mohammed Fetiha, Tesema Hailemariam Getachew, Ahmed Siraj, Mohammed Ayub, Regasa Teshome, Obsa Mohammed Suleiman
Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
Department of Anesthesiology, College of Health Sciences and Medicine, Hawasa University, Dilla, Ethiopia.
Front Med (Lausanne). 2022 Feb 9;9:814538. doi: 10.3389/fmed.2022.814538. eCollection 2022.
Cesarean section (CS) has been one of the most frequently performed major surgical interventions and causes severe postoperative pain. Spinal opioid and abdominal field block have been investigated as effective analgesia for postoperative pain and reduce the need for systemic medications and associated side effects. The aim of the current study is to compare spinal morphine (SM) and bilateral landmark oriented transversus abdominis plane (TAP) block for postoperative pain management.
In this randomized controlled trial, 114 pregnant mothers scheduled for CS under spinal anesthesia were allocated randomly to receive either SM 0.1 mg (group SM; = 56) or bilateral landmark-oriented TAP block with 20 ml of 0.25% of bupivacaine (group TAP; = 52). A comparison of numerical variables between study groups was done using unpaired student -test and Mann-Whitney test for symmetric and asymmetric data, respectively. Time to event variable was analyzed by using Kaplan-Meir's survival function. A -value of < 0.05 was considered statistically significant.
A total of 114 patients were recruited and randomly assigned and received interventions. Among them, 108 patients completed this study. Time to first analgesic request was significantly shorter in the TAP block compared to SM. Twenty-four-hour median morphine consumption was reduced in the SM group compared to the TAP block ( < 0.001). Median postoperative pain score during movement and rest shows statistically significant differences between groups ( < 0.001).
The addition of preservative-free 100 μg SM provides prolonged postoperative analgesia time, superior postoperative analgesia, and less postoperative opioid consumption compared to the TAP block.
剖宫产术（CS）一直是最常施行的大型外科手术之一，且会导致严重的术后疼痛。脊髓阿片类药物和腹部区域阻滞已被研究作为术后疼痛的有效镇痛方法，可减少全身用药的需求及相关副作用。本研究的目的是比较脊髓吗啡（SM）和双侧标志性腹横肌平面（TAP）阻滞用于术后疼痛管理的效果。
在这项随机对照试验中，114名计划在脊髓麻醉下进行剖宫产的孕妇被随机分配，分别接受0.1毫克SM（SM组；n = 56）或用20毫升0.25%布比卡因进行双侧标志性TAP阻滞（TAP组；n = 52）。分别使用不成对学生t检验和曼-惠特尼检验对研究组之间的数值变量进行比较，以分析对称和不对称数据。采用Kaplan-Meir生存函数分析事件发生时间变量。P值<0.05被认为具有统计学意义。
共招募了114名患者并随机分配接受干预。其中，108名患者完成了本研究。与SM组相比，TAP阻滞组首次镇痛需求的时间明显更短。与TAP阻滞组相比，SM组24小时吗啡消耗量降低（P<0.001）。两组在活动和休息时的术后疼痛评分中位数显示出统计学差异（P<0.001）。
与TAP阻滞相比，添加不含防腐剂的100微克SM可延长术后镇痛时间，提供更好的术后镇痛效果，并减少术后阿片类药物的消耗量。
