脂质体布比卡因硬膜外镇痛联合腹横肌平面阻滞可减轻剖宫产术后疼痛：一项双盲随机对照试验
Epidural analgesia combined with transversus abdominis plane block with liposomal bupivacaine reduces pain after caesarean delivery: a double-blind, randomised controlled trial.
作者信息
Ma Wei, Long Yanxi, Ye Shanshan, Tao Qiang, Wang Yang, Xu Tao
机构信息
Department of Anaesthesiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
出版信息
Front Med (Lausanne). 2025 Aug 29;12:1653815. doi: 10.3389/fmed.2025.1653815. eCollection 2025.
BACKGROUND
Sustained release of bupivacaine can be achieved by encapsulating bupivacaine within multivesicular liposomes, providing localised analgesia for up to 72 h. This study aimed to evaluate whether a multimodal analgesic approach integrating epidural analgesia with liposomal bupivacaine enhanced transversus abdominis plane block could extend the interval to initial opioid use and thus reduce the total post-operative opioid requirements in women undergoing caesarean section.
METHODS
Women scheduled for elective caesarean delivery under combined spinal-epidural anaesthesia were randomly assigned to a liposomal bupivacaine or placebo group. All participants were given 0.75% ropivacaine 15 mg intrathecally at L3-L4 interspace. Before surgical closure, 0.6 mg of epidural hydromorphone was administered. Bilateral ultrasound-guided lateral transversus abdominis plane blocks were performed after surgery. The liposomal bupivacaine group received 133 mg liposomal bupivacaine in 20 mL fluid per side, whereas the placebo control group received 20 mL saline per side. Postoperative analgesia included scheduled oral acetaminophen and self-administered boluses of oxycodone as needed. The primary outcomes were 24- and 48-h oxycodone consumption.
RESULTS
A total of 128 women were enrolled. The median [interquartile range (IQR)] postoperative cumulative oxycodone consumption was significantly lower in the liposomal bupivacaine group than in the placebo group at 24 h [2 (0-5) mg vs. 4 (1-8) mg, = 0.009] and 48 h [8 (0-13) mg vs. 10 (4-18) mg, = 0.022], and the median (IQR) interval to first patient-controlled analgesia use was significantly longer in the liposomal bupivacaine group than in the placebo group [22 (12-48) vs. 8 (4-18) h; < 0.001].
CONCLUSION
Epidural hydromorphone combined with liposomal bupivacaine enhances transversus abdominis plane block, prolongs analgesia duration and reduces opioid requirements in the first 48 h after caesarean-section.
CLINICAL TRIAL REGISTRATION
https://www.chictr.org.cn/showproj.html?proj=237618, Identifier [ChiCTR2400087477].
背景
通过将布比卡因包裹在多囊脂质体内可实现其持续释放，从而提供长达72小时的局部镇痛。本研究旨在评估将硬膜外镇痛与脂质体布比卡因相结合的多模式镇痛方法是否能增强腹横肌平面阻滞，从而延长首次使用阿片类药物的间隔时间，并因此减少剖宫产妇女术后阿片类药物的总需求量。
方法
计划在腰麻-硬膜外联合麻醉下行择期剖宫产的妇女被随机分配至脂质体布比卡因组或安慰剂组。所有参与者均在L3-L4间隙鞘内注射0.75%罗哌卡因15mg。手术缝合前，硬膜外注射0.6mg氢吗啡酮。术后进行双侧超声引导下的腹横肌平面阻滞。脂质体布比卡因组每侧在20ml液体中注射133mg脂质体布比卡因，而安慰剂对照组每侧注射20ml生理盐水。术后镇痛包括定时口服对乙酰氨基酚以及按需自行注射羟考酮。主要结局指标为术后24小时和48小时的羟考酮消耗量。
结果
共纳入128名妇女。脂质体布比卡因组术后羟考酮累积消耗量的中位数[四分位间距（IQR）]在24小时时显著低于安慰剂组[2（0-5）mg对4（1-8）mg，P = 0.009]，在48小时时也显著低于安慰剂组[8（0-13）mg对10（4-18）mg，P = 0.022]，且脂质体布比卡因组首次使用患者自控镇痛的间隔时间中位数（IQR）显著长于安慰剂组[22（12-48）对8（4-18）小时；P < 0.001]。
结论
硬膜外氢吗啡酮联合脂质体布比卡因可增强腹横肌平面阻滞，延长镇痛持续时间，并减少剖宫产术后48小时内的阿片类药物需求量。
临床试验注册
https://www.chictr.org.cn/showproj.html?proj=237618，标识符[ChiCTR2400087477] 。
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