Gu Yang, Yang Fan, Bao Jiamin, Wang Fa, Tian Biyun, Sun Hui, Li Ningkang, Ye Qingshan
Department of Anesthesiology, Ningxia Medical University, Yinchuan, China.
Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, Ningxia, China.
Front Med (Lausanne). 2025 Jul 29;12:1593574. doi: 10.3389/fmed.2025.1593574. eCollection 2025.
The management of post-cesarean pain exhibits considerable variation across different regions and hospitals, with a prevalent tendency to utilize opioid medications as the primary analgesic approach. This study investigates the impact of different doses of dexmedetomidine combined with dexamethasone as an adjunct to transversus abdominis plane block (TAPB) on the analgesic efficacy and quality of recovery following cesarean section.
In this prospective randomized clinical trial, 90 patients scheduled for cesarean section were randomly assigned in a 1:1:1 ratio to receive postoperative TAPB with one of three solutions: 8 mg dexamethasone with 0.375% ropivacaine (Group C), 0.5 μg/kg dexmedetomidine with 8 mg dexamethasone and 0.375% ropivacaine (Group D1), or 1 μg/kg dexmedetomidine with 8 mg dexamethasone and 0.375% ropivacaine (Group D2). The primary outcome measures were the VAS scores for rest and movement at 6, 12, 24, and 48 h post TAPB, as well as the incidence of moderate to severe pain.
Postoperative VAS scores demonstrated distinct patterns between rest and dynamic pain. At rest, no significant differences were observed among groups C, D1, and D2 at any time point (6-48 h; all > 0.05). For dynamic pain, group C exhibited higher median scores than D1 and D2 at 12 h [3.00 (IQR 2.00-4.00) vs. 1.00 (1.00-3.00), median difference 1.00 (95% CI 1.00-2.00); = 0.001; vs. 2.00 (1.00-3.00), difference 1.00 (0.00-2.00); = 0.003] and 24 h [4.00 (3.00-4.00) vs. D1: 3.00 (2.00-3.00), difference 1.00 (0.00-1.00); < 0.001; vs. D2: 2.00 (2.00-3.00), difference 1.00 (1.00-2.00); = 0.009]. By 48 h, D2 showed the lowest dynamic pain scores [1.00 (1.00-2.00) vs. C: 3.00 (2.00-3.00); difference 1.00 (1.00-1.00); = 0.001]. Moderate-to-severe dynamic pain incidence differed significantly at 12 h (C: 26.7%; D1: 13.3%; D2: 3.3%; = 0.04) and peaked in group C at 24 h [53.3% vs. D1: 13.3% (risk ratio 7.43, 95% CI 2.08-26.55; = 0.002) and D2: 10.0% (risk ratio 10.29, 2.56-41.37; = 0.001)]. No intergroup differences were observed for resting pain or dynamic pain at 48 h. Groups D1 and D2 showed no significant differences in outcomes at any time point.
Adding dexmedetomidine and dexamethasone to ropivacaine for TAPB can improve post-cesarean section pain conditions.
https://clinicaltrials.gov/, ChiCTR2400081531.
剖宫产术后疼痛的管理在不同地区和医院存在很大差异，普遍倾向于使用阿片类药物作为主要镇痛方法。本研究探讨不同剂量右美托咪定联合地塞米松作为腹横肌平面阻滞（TAPB）辅助用药对剖宫产术后镇痛效果及恢复质量的影响。
在这项前瞻性随机临床试验中，90例计划行剖宫产的患者按1:1:1比例随机分为三组，术后接受TAPB并使用以下三种溶液之一：8 mg地塞米松加0.375%罗哌卡因（C组）、0.5 μg/kg右美托咪定加8 mg地塞米松和0.375%罗哌卡因（D1组）、1 μg/kg右美托咪定加8 mg地塞米松和0.375%罗哌卡因（D2组）。主要观察指标为TAPB后6、12、24和48小时静息和活动时的视觉模拟评分（VAS），以及中重度疼痛的发生率。
术后VAS评分在静息痛和动态痛之间呈现出不同模式。静息时，C组、D1组和D2组在任何时间点（6 - 48小时；均P>0.05）均未观察到显著差异。对于动态痛，C组在12小时[3.00（四分位间距2.00 - 4.00）vs. D1组：1.00（1.00 - 3.00），中位数差异1.00（95%置信区间1.00 - 2.00）；P = 0.001]和24小时[4.00（3.00 - 4.00）vs. D1组：3.00（2.00 - 3.00），差异1.00（0.00 - 1.00）；P<0.001]的中位数评分高于D1组和D2组，在24小时与D2组比较[4.00（3.00 - 4.00）vs. D2组：2.00（2.00 - 3.00），差异1.00（1.00 - 2.00）；P = 0.009]。到48小时，D2组动态痛评分最低[1.00（1.00 - 2.00）vs. C组：3.00（2.00 - 3.00）；差异1.00（1.00 - 1.00）；P = 0.001]。中重度动态痛发生率在12小时有显著差异（C组：26.7%；D1组：13.3%；D2组：3.
