Balakrishna Komalea Priya, Kagalkar Nirmala Devi, Suntan Anusha
Anesthesiology, Shri B M Patil Medical College and Hospital, Vijayapura, IND.
Anesthesiology, Shri B M Patil Medical College and Hospital, Bijapur Lingayat District Educational (BLDE) University, Vijayapura, IND.
Cureus. 2023 Apr 5;15(4):e37156. doi: 10.7759/cureus.37156. eCollection 2023 Apr.
Background Major abdominal surgeries are often accompanied by excruciating pain, which, if not adequately managed, can reduce patient comfort and satisfaction, delay mobilization, compromise respiratory and cardiac functioning, and increase healthcare costs. The transversus abdominis plane (TAP) block is an efficient and safe complement to multimodal postoperative analgesia for abdominal surgery. This study evaluates the efficacy of combining magnesium sulfate (MgSO) with bupivacaine for TAP block in patients posted for total abdominal hysterectomy (TAH). Methodology Seventy female patients between the ages of 35 and 60 who were scheduled to have a TAH under spinal anesthesia were divided randomly into two groups of 35 each: group Bupivacaine (B) and group Bupivacaine-Magnesium sulfate (BM). Group B received 18 milliliters (mL) of bupivacaine 0.25 percentage (%) 45 milligrams (mg) with 2 mL normal saline (NS) whereas group BM received 18 mL of bupivacaine 0.25% (45 mg) with 1.5 mL of 10% weight/volume (w/v) MgSO (150 mg) and 0.5 mL NS in the ultrasonography-guided (USG) bilateral TAP block performed after the end of surgery. Groups were compared for the postoperative visual analog scale (VAS) scores, the time required for first rescue analgesia, the number of analgesic rescues at various time intervals, patient satisfaction score, and any side effects. Results Postoperative VAS scores at 4, 6, 12 and 24th hour (hr) (p < 0.05) in group BM were lower compared to group B. Time required for rescue analgesia was significantly prolonged in group BM (882.94 ± 70.22 minutes) compared to group B (459 ± 100.53 minutes) with minimal usage of rescue analgesia (p < 0.05) up to 12 hr. In group BM, the patient satisfaction score was higher (p = 0.001). Conclusion In addition to a considerable reduction in post operative VAS scores and overall use of rescue analgesia, the addition of magnesium to bupivacaine significantly prolongs the TAP block and increases the initial postoperative period of bearable pain.
大型腹部手术常伴有剧痛，若疼痛控制不当，会降低患者舒适度和满意度，延迟活动，影响呼吸和心脏功能，并增加医疗成本。腹横肌平面（TAP）阻滞是腹部手术多模式术后镇痛的一种有效且安全的补充方法。本研究评估硫酸镁（MgSO）与布比卡因联合用于接受全腹子宫切除术（TAH）患者的TAP阻滞的疗效。
70例年龄在35至60岁之间、计划在脊髓麻醉下进行TAH的女性患者被随机分为两组，每组35例：布比卡因组（B组）和布比卡因 - 硫酸镁组（BM组）。B组接受18毫升（mL）0.25%（45毫克（mg））布比卡因加2毫升生理盐水（NS），而BM组在手术结束后进行的超声引导（USG）双侧TAP阻滞中接受18 mL 0.25%（45 mg）布比卡因加1.5 mL 10%重量/体积（w/v）MgSO（150 mg）和0.5 mL NS。比较两组的术后视觉模拟评分（VAS）、首次补救镇痛所需时间、不同时间间隔的镇痛补救次数、患者满意度评分及任何副作用。
BM组术后4、6、12和24小时（hr）的VAS评分（p < 0.05）低于B组。与B组（459 ± 100.53分钟）相比，BM组补救镇痛所需时间显著延长（882.94 ± 70.22分钟），且在12小时内补救镇痛的使用最少（p < 0.05）。在BM组中，患者满意度评分更高（p = 0.001）。
除了显著降低术后VAS评分和总体补救镇痛的使用外，布比卡因中添加镁可显著延长TAP阻滞时间，并增加术后初始可耐受疼痛的时间。
