Sirin Betul Yusra, Teomete Gulsen, Bilgili Beliz
Department of Anesthesiology and Reanimation, Istanbul Sancaktepe Doctor Ilhan Varank Research and Training Hospital.
Department of Anesthesiology and Reanimation, Istanbul Marmara University Hospital, Istanbul, Turkey.
Clin J Pain. 2025 Apr 1;41(4):e1274. doi: 10.1097/AJP.0000000000001274.
After cesarean, optimal analgesia is important for early mobilization, mitigating thromboembolic risks, and mother-infant communication. Our study compared the postoperative analgesic effects of intrathecal morphine (ITM) and erector spinae plane block (ESPB) in elective cesarean section under spinal anesthesia.
Eighty-two patients were randomized into ESPB and ITM groups. Both groups received spinal anesthesia with 10 mg of heavy bupivacaine. In the ITM group, ITM (100 mcg) was added. The ESPB group received bilateral T10 level ESPB with 20 mL 0.25% bupivacaine postoperatively. Postoperative pain control included intravenous paracetamol 4x1 g, intravenous patient-controlled analgesia with tramadol, and diclofenac 75 mg for rescue analgesia when Numeric Rating Scale (NRS) >4. NRS, tramadol consumption, and side effects were recorded 24 hours postoperatively. The primary outcome of this study is to compare 24-hour postoperative opioid consumption after cesarean sections. Secondary outcomes include postoperative pain scores, rescue analgesia needs, and side effects.
NRS scores ≤4 at all time intervals and were comparable among groups. The total 24-hour tramadol consumption was significantly higher in the ESPB group (median: 75; Q1, Q3 [40, 140]) compared with ITM (50 [27.5, 60], P = 0.008). Tramadol consumption was similar among groups during 0 to 6 and 6 to 12 hours. In the 12 to 24 hours, tramadol consumption was significantly higher in the ESPB group (22.5 [15, 57.5]) compared with ITM (15 [12.5, 25], P = 0.005). In the ITM group, nausea and vomiting were observed in 3 patients and itching in 1 patient; no adverse effects were observed in the patients in the ESPB group.
For patients undergoing cesarean section under spinal anesthesia, ITM reduced opioid consumption more effectively than ESPB. ESPB is not recommended as a primary analgesic option for cesarean sections.
剖宫产术后，最佳镇痛对于早期活动、降低血栓栓塞风险以及母婴交流至关重要。我们的研究比较了鞘内注射吗啡（ITM）和竖脊肌平面阻滞（ESPB）在腰麻下行择期剖宫产术后的镇痛效果。
82例患者被随机分为ESPB组和ITM组。两组均接受10mg重比重布比卡因腰麻。ITM组加用ITM（100μg）。ESPB组术后在T10水平行双侧ESPB，注射20mL 0.25%布比卡因。术后疼痛控制包括静脉注射对乙酰氨基酚4次，每次1g，静脉自控镇痛使用曲马多，当数字评分量表（NRS）>4时给予双氯芬酸75mg用于补救镇痛。术后24小时记录NRS、曲马多用量及副作用。本研究的主要结局是比较剖宫产术后24小时的阿片类药物用量。次要结局包括术后疼痛评分、补救镇痛需求及副作用。
各时间点NRS评分均≤4，且组间可比。ESPB组24小时曲马多总用量（中位数：75；四分位数间距[40, 140]）显著高于ITM组（50[27.5, 60]，P = 0.008）。0至6小时和6至12小时期间，两组曲马多用量相似。在12至24小时，ESPB组曲马多用量（22.5[15, 57.5]）显著高于ITM组（15[12.5, 25]，P = 0.005）。ITM组有3例患者出现恶心呕吐，1例患者出现瘙痒；ESPB组患者未观察到不良反应。
对于腰麻下行剖宫产的患者，ITM比ESPB更有效地减少了阿片类药物的用量。不推荐将ESPB作为剖宫产的主要镇痛选择。
