Qin Yongyi, Yang Yujiao, Qin Sulan, Xiong Zhaohui
Clinical School of North Sichuan Medical College, Nanchong, Sichuan, China.
Department of Anesthesiology, Guang'an People's Hospital, Guang'an, Sichuan, China.
Medicine (Baltimore). 2024 Dec 27;103(52):e41159. doi: 10.1097/MD.0000000000041159.
Of all obstetric operations, cesarean section is one of the most common. The impact of postoperative pain on physical and mental health in women cannot be ignored. Moreover, effective postoperative analgesia is essential in women who have given birth. Traditional systemic analgesic methods (intravenous analgesia, oral analgesics, etc) are often accompanied by adverse reactions that are positively correlated with the drug dosage. Regional nerve block is an analgesic and anesthetic technique that temporarily blocks nerve conduction by injecting local anesthetics around the nerve roots, nerve trunks, nerve plexus, ganglia, or surgical area, thereby alleviating or eliminating pain. Currently, the regional block techniques used for postoperative analgesia following cesarean section include paravertebral nerve block, transversus abdominis plane block, rectus sheath block, quadratus lumborum block, ilioinguinal-iliohypogastric nerve block, erector spinae block, wound infiltration analgesia, and intraperitoneal infusion of local anesthetics. These regional block techniques hold great promise for providing effective postoperative analgesia after cesarean section, each with unique advantages. Moreover, regional blocks have a unique place in multimodal analgesia protocols following cesarean section and are increasingly used in clinical practice for analgesia after cesarean section. This review provides an overview of the regional nerve block techniques used for postoperative analgesia following cesarean section, discusses their benefits and drawbacks, and provides a reference for choosing postoperative pain management following cesarean delivery, offering a hopeful outlook for improved patient care.
在所有产科手术中,剖宫产是最常见的手术之一。术后疼痛对女性身心健康的影响不容忽视。此外,有效的术后镇痛对于产妇至关重要。传统的全身镇痛方法(静脉镇痛、口服镇痛药等)常常伴有与药物剂量呈正相关的不良反应。区域神经阻滞是一种镇痛和麻醉技术,通过在神经根、神经干、神经丛、神经节或手术区域周围注射局部麻醉药来暂时阻断神经传导,从而减轻或消除疼痛。目前,用于剖宫产术后镇痛的区域阻滞技术包括椎旁神经阻滞、腹横肌平面阻滞、腹直肌鞘阻滞、腰方肌阻滞、髂腹股沟 - 髂腹下神经阻滞、竖脊肌阻滞、伤口浸润镇痛以及局部麻醉药腹腔内输注。这些区域阻滞技术在提供有效的剖宫产术后镇痛方面具有很大潜力,每种技术都有独特的优势。此外,区域阻滞在剖宫产术后多模式镇痛方案中占有独特地位,并且在剖宫产术后镇痛的临床实践中越来越多地被使用。本文综述了用于剖宫产术后镇痛的区域神经阻滞技术,讨论了它们的优缺点,并为剖宫产术后疼痛管理的选择提供参考,为改善患者护理带来了希望。