Xue Mengwen, Guo Cong, Han Kunyu, Bai Ruiping, An Rui, Shen Xin
Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
Department of Anesthesiology, Hanzhong People's Hospital, Hanzhong, 723000, Shaanxi, China.
Pain Ther. 2022 Dec;11(4):1287-1298. doi: 10.1007/s40122-022-00425-6. Epub 2022 Aug 18.
Complete postoperative analgesia is very important for puerperae after cesarean section. The objective of this study was to explore the optimal postoperative analgesia after cesarean section.
A total of 180 full-term puerperae who underwent cesarean section in Hanzhong People's Hospital from March 2019 to March 2020 were enrolled and were randomly divided into three groups. Group A was given 0.9% normal saline, group B and C were given 0.4% ropivacaine for transversus abdominis plane block (TAPB). Postoperative patient-controlled intravenous analgesia (PCIA) pumps were 2 μg/kg sufentanil + 2.5 mg droperidol, 1.5 μg/kg and 1.3 μg/kg sufentanil, respectively. All puerperae were given different but effective analgesia programs. The primary outcome indicators were visual analog scores (VAS), the first compression time of postoperative analgesia pump and the total number of compressions in 48 h. The secondary outcome indicators were vital signs, Ramsay sedation scores, comfort scores (BCS), the frequency of analgesic rescue, postoperative side effects and satisfaction.
The dynamic and static VAS scores of the puerperae in group B at T and T were significantly lower than group A and at T, T and T were significantly lower than group C. Compared with group A, the dynamic and static VAS scores of puerperae in group C were lower at T and T and higher at T, T and T. The Ramsay score and BCS score of the puerperae in group C at T, T and T were significantly lower than those in groups A and B.
PCIA with sufentanil alone or combined with TAPB can be safely and effectively used for postoperative analgesia after cesarean section. PCIA combined with TAPB had better analgesic effect and lower incidence of side effects while reducing the dose of opioids. The results of this study provide new ideas and insights for the choice of analgesia after cesarean section.
剖宫产术后的充分镇痛对产妇非常重要。本研究的目的是探讨剖宫产术后的最佳镇痛方法。
选取2019年3月至2020年3月在汉中市人民医院行剖宫产术的180例足月产妇,随机分为三组。A组给予0.9%生理盐水,B组和C组给予0.4%罗哌卡因行腹横肌平面阻滞(TAPB)。术后患者自控静脉镇痛(PCIA)泵分别为2μg/kg舒芬太尼+2.5mg氟哌利多、1.5μg/kg舒芬太尼和1.3μg/kg舒芬太尼。所有产妇均给予不同但有效的镇痛方案。主要结局指标为视觉模拟评分(VAS)、术后镇痛泵首次按压时间及48小时内按压总次数。次要结局指标为生命体征、Ramsay镇静评分、舒适度评分(BCS)、镇痛补救频率、术后副作用及满意度。
B组产妇在T、T时的动态和静态VAS评分显著低于A组,在T、T和T时显著低于C组。与A组相比,C组产妇在T、T时的动态和静态VAS评分较低,在T、T和T时较高。C组产妇在T、T和T时的Ramsay评分和BCS评分显著低于A组和B组。
单纯舒芬太尼PCIA或联合TAPB可安全有效地用于剖宫产术后镇痛。PCIA联合TAPB镇痛效果更好,副作用发生率更低,同时减少了阿片类药物的用量。本研究结果为剖宫产术后镇痛方法的选择提供了新的思路和见解。