Atatürk University, Faculty of Medicine, Department of Anesthesiology and Reanimation - Erzurum, Turkey.
Atatürk University, Anesthesiology Clinical Research Office - Erzurum, Turkey.
Rev Assoc Med Bras (1992). 2023 Nov 13;69(12):e20230867. doi: 10.1590/1806-9282.20230867. eCollection 2023.
This prospective randomized study was conducted at Ataturk University Medical Faculty Hospital, Department of Anesthesia and Reanimation, from June 2022 to May 2023. The aim of this study was to compare the effectiveness of ultrasound-guided erector spinae plane block, quadratus lumborum block, and intrathecal morphine to decrease postoperative pain after cesarean section.
Sixty-term pregnant women who were scheduled for elective cesarean sections with spinal anesthesia were included. Patients were randomly divided into three groups (n=20 for each group): Group 1: Patients were administered intrathecal morphine during spinal anesthesia; Group 2: Patients performed bilateral erector spinae plane block postoperatively; and Group 3: Patients performed bilateral quadratus lumborum block postoperatively. In the postpartum care unit, patients received intravenous Patient-Controlled Analgesia. The Patient-Controlled Analgesia devices were set to administer an intravenous bolus of 25 μg fentanyl, with a lockout interval of 10 min. Opioid consumption and maximum pain score in the 24 postoperative hours were recorded.
Patients in Group 1 had a longer time to first analgesic requirement compared to Group 2 (p=0.017). Opioid consumption and resting and moving visual analog score scores in the first 24 h postoperatively were similar between groups.
All three methods, including intrathecal morphine, erector spinae plane block, and quadratus lumborum block, are efficacious and comparable in providing postoperative analgesia after cesarean under spinal anesthesia.
本前瞻性随机研究于 2022 年 6 月至 2023 年 5 月在阿塔图尔克大学医学院麻醉与复苏系进行。本研究的目的是比较超声引导竖脊肌平面阻滞、腰方肌阻滞和鞘内吗啡在减少剖宫产术后疼痛的效果。
纳入 60 名计划行脊髓麻醉剖宫产的足月孕妇。患者随机分为三组（每组 20 例）：组 1：脊髓麻醉时给予鞘内吗啡；组 2：术后行双侧竖脊肌平面阻滞；组 3：术后行双侧腰方肌阻滞。在产后护理单元，患者接受静脉自控镇痛。静脉自控镇痛装置设置为静脉注射 25μg 芬太尼，锁定间隔 10min。记录术后 24 小时内的阿片类药物消耗和最大疼痛评分。
与组 2 相比，组 1 患者首次需要镇痛的时间更长（p=0.017）。术后 24 小时内阿片类药物消耗和静息及运动视觉模拟评分在各组间相似。
鞘内吗啡、竖脊肌平面阻滞和腰方肌阻滞三种方法在脊髓麻醉下剖宫产术后均有效且效果相当。
