Einarsson Rachel, Knowles Joshua
Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2025 Feb;65(1):135-139. doi: 10.1111/ajo.13871. Epub 2024 Aug 1.
Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post-caesarean section ultrasound-guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment. No previous examination of surgical TAP blocks in patients having undergone emergency caesarean section has been undertaken.
To investigate surgical TAP block and multimodal analgesic use during emergency caesarean section, the effect on surgical time, post-operative analgesia use, and admission length.
We performed a retrospective review of 250 patients who underwent emergency caesarean in 2022. Surgical TAP blocks were performed with 20 mL of 0.375% ropivacaine either side. Primary outcomes included surgical time, length of admission, time to first request of rescue opiate, opiate use in first post-operative 24 h, total dose used during admission, and opiates prescribed on discharge.
Ninety-six patients received surgical TAP blocks, and 154 did not. There were no statistically significant differences in the primary outcomes. Subgroup analyses were performed in patients who did not receive intrathecal morphine, body mass index over 30 kg/m, for patients whom this was their first caesarean, and for TAP blocks versus local infiltration to the wound. There were no significant differences in the primary outcomes in these subgroups.
Surgical TAP blocks did not prolong surgical time or decrease post-operative analgesia use or admission length in patients having undergone emergency caesarean. Patient-tailored multimodal analgesia is encouraged, although more research is needed.
对于产后患者和新生儿的健康而言，具备最小副作用的有效镇痛药至关重要。剖宫产术后超声引导下腹横肌平面（TAP）阻滞已证实具有安全性和有效性。外科TAP阻滞似乎有效且所需时间和设备较少。此前尚未对接受急诊剖宫产的患者进行过外科TAP阻滞的研究。
研究急诊剖宫产期间外科TAP阻滞和多模式镇痛的使用情况，以及对手术时间、术后镇痛药物使用和住院时长的影响。
我们对2022年接受急诊剖宫产的250例患者进行了回顾性研究。在两侧使用20毫升0.375%的罗哌卡因进行外科TAP阻滞。主要结局包括手术时间、住院时长、首次请求使用急救阿片类药物的时间、术后24小时内阿片类药物的使用情况、住院期间使用的总剂量以及出院时开具的阿片类药物。
96例患者接受了外科TAP阻滞，154例未接受。主要结局在统计学上无显著差异。对未接受鞘内吗啡、体重指数超过30kg/m²、首次剖宫产的患者以及TAP阻滞与伤口局部浸润的患者进行了亚组分析。这些亚组的主要结局无显著差异。
在接受急诊剖宫产的患者中，外科TAP阻滞并未延长手术时间，也未减少术后镇痛药物的使用或住院时长。尽管还需要更多研究，但鼓励采用针对患者的多模式镇痛。
