Urfalı Senem, Hakimoğlu Sedat, Turhanoğlu Selim, Koyuncu Onur
Department of Anesthesiology and Reanimation, Tayfur Ata Sokmen Medical Faculty, Hatay Mustafa Kemal University, 31040 Hatay, Turkey.
J Clin Med. 2024 Jul 22;13(14):4270. doi: 10.3390/jcm13144270.
: The transversus abdominis plane (TAP) block is providing effective postoperative analgesia in patients undergoing cesarean section (CS). This study aims to evaluate and compare the effects on pain levels of bupivacaine alone versus bupivacaine combined with dexmedetomidine and bupivacaine combined with dexamethasone in ultrasound-guided TAP block for postoperative pain after CS. : In this randomized controlled trial, 120 patients with American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups. At the end of the surgery, an ultrasound-guided TAP block was performed on all patients: bupivacaine 0.5% (Group B), bupivacaine 0.5% + dexmedetomidine (1 µg/kg) (Group BD), and bupivacaine 0.5% + dexamethasone (4 mg) (Group BDx). Postoperatively, all patients were evaluated at 0, 1, 4, 8, 16, and 24 h for visual analog scores VASs, tramadol consumption, complications, and patient satisfaction. A p value of < 0.05 is statistically significant. : At 0 h, VASs in the sitting and supine positions were significantly higher in the BDx group (0.85 ± 1.61 and 0.85 ± 1.36, respectively) compared to the B group (0.05 ± 0.32 in both positions) and the BD group (0.15 ± 0.48 in both positions) ( = 0.005 and = 0.001, respectively). At the 24th hour, VASs in the sitting and supine positions were significantly lower in the BDx group (1.7 ± 1.2 and 1.43 ± 1.05) compared to the B group (2.3 ± 0.68 and 2.2 ± 0.72) and the BD group (2.57 ± 1.01 and 2.28 ± 0.78) ( = 0.005 and = 0.001, respectively). At 0 h, the tramadol requirement was highest in the BDx group at 12.5%, while it was not required in the B and BD groups ( = 0.005). At 0 h, the rate of nausea and vomiting was highest in the BDx group at 17.5%, compared to 2.5% in the BD group and 0% in the B group ( = 0.003). Patient satisfaction scores were higher in the dexamethasone group compared to the other groups. This was significant between Group B and Group BDx ( = 0.009 < 0.05). : Adding dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks reduces postoperative pain and increases patient satisfaction after cesarean sections. Dexamethasone, due to its delayed onset but extended duration, achieves lower pain scores and higher satisfaction. Further research is necessary to confirm these findings.
腹横肌平面（TAP）阻滞可为剖宫产（CS）患者提供有效的术后镇痛。本研究旨在评估和比较在超声引导下TAP阻滞中，单独使用布比卡因与布比卡因联合右美托咪定以及布比卡因联合地塞米松对CS术后疼痛程度的影响。
在这项随机对照试验中，将120例拟在脊髓麻醉下行择期剖宫产的美国麻醉医师协会（ASA）身体状况I级和II级患者随机分为三组。手术结束时，对所有患者进行超声引导下的TAP阻滞：0.5%布比卡因组（B组）、0.5%布比卡因 + 右美托咪定（1μg/kg）组（BD组）和0.5%布比卡因 + 地塞米松（4mg）组（BDx组）。术后，在0、1、4、8、16和24小时对所有患者进行视觉模拟评分（VAS）、曲马多用量、并发症及患者满意度评估。p值<0.05具有统计学意义。
在0小时时，BDx组坐位和仰卧位的VAS显著高于B组（两个体位均为0.05±0.32）和BD组（两个体位均为0.15±0.48）（分别为p = 0.005和p = 0.001）。在第24小时，BDx组坐位和仰卧位的VAS显著低于B组（2.3±0.68和2.2±0.72）和BD组（2.57±1.01和2.28±0.78）（分别为p = 0.005和p = 0.001）。在0小时时，BDx组曲马多需求量最高，为12.5%，而B组和BD组不需要（p = 0.005）。在0小时时，BDx组恶心呕吐发生率最高，为17.5%，而BD组为2.5%，B组为0%（p = 0.003）。地塞米松组患者满意度得分高于其他组。B组和BDx组之间差异显著（p = 0.009<0.05）。
在超声引导下TAP阻滞中，布比卡因联合右美托咪定或地塞米松可减轻剖宫产术后疼痛并提高患者满意度。地塞米松由于起效延迟但持续时间延长，可实现更低的疼痛评分和更高的满意度。需要进一步研究来证实这些发现。
