腰方肌阻滞在全身麻醉剖宫产患者术后镇痛中的应用
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摘要
目的观察腰方肌阻滞在全身麻醉剖宫产患者术后镇痛中的应用。方法 50例全身麻醉下行剖宫产手术患者,按随机数字表法分为两组:腰方肌阻滞组(Q组,n=25)患者术毕后超声引导下于双侧后路腰方肌阻滞点注射0. 3%罗哌卡因25 ml,对照组(C组,n=25)患者术毕后相同部位消毒但不行穿刺。记录患者手术后2、6、12、24、48 h疼痛视觉模拟评分(VAS)及疼痛舒适度评分(BCS)。记录患者一般情况、生命体征及术后镇痛相关不良反应。结果两组产妇一般资料及手术相关指标差异无统计学意义(P> 0. 05)。Q组产妇手术后2、6、12、24 h的VAS评分均低于对照组,BCS评分高于对照组(P <0. 05)。两组产妇术后48 h的VAS评分、BCS评分及不良反应发生率比较差异无统计学意义(P> 0. 05)。结论后路腰方肌阻滞联合静脉镇痛可以减轻全身麻醉剖宫产手术产妇术后24 h内疼痛评分,提高术后镇痛舒适度。
Objective To observe the analgesic effect of quadratus lumborum block( QLB) in cesarean section under general anesthesia. Methods 50 patients underwent cesarean section under general anesthesia were randomly divided into two groups( n = 25) : patients in QLB group( group Q) received QLB at the end of surgery with 0. 3% ropivacaine 25 ml,and the control group( group C) patients were disinfected at the same site but did not puncture. The visual analogue scale( VAS) and pain Bruggrmann comfort score( BCS) were recorded at 2,6,12,24,and 48 hours after surgery. The patient's general condition,vital signs and postoperative analgesia-related adverse reactions were recorded. Results There were no significant differences between the two groups in general information and surgical related indexes( P >0. 05). The VAS scores of the Q group were lower than the control group at 2,6,12 and 24 hours,and the BCS score was higher than that in the control group( P < 0. 05). There was no difference in VAS score,BCS score after 48 hours,and no difference in adverse reaction rate between the two groups( P > 0. 05).Conclusions Quadratus lumborum block combined with intravenous analgesia can reduce the pain score within 24 hours after cesarean section under general anesthesia and improve postoperative analgesia comfort.
Objective To observe the analgesic effect of quadratus lumborum block( QLB) in cesarean section under general anesthesia. Methods 50 patients underwent cesarean section under general anesthesia were randomly divided into two groups( n = 25) : patients in QLB group( group Q) received QLB at the end of surgery with 0. 3% ropivacaine 25 ml,and the control group( group C) patients were disinfected at the same site but did not puncture. The visual analogue scale( VAS) and pain Bruggrmann comfort score( BCS) were recorded at 2,6,12,24,and 48 hours after surgery. The patient's general condition,vital signs and postoperative analgesia-related adverse reactions were recorded. Results There were no significant differences between the two groups in general information and surgical related indexes( P >0. 05). The VAS scores of the Q group were lower than the control group at 2,6,12 and 24 hours,and the BCS score was higher than that in the control group( P < 0. 05). There was no difference in VAS score,BCS score after 48 hours,and no difference in adverse reaction rate between the two groups( P > 0. 05).Conclusions Quadratus lumborum block combined with intravenous analgesia can reduce the pain score within 24 hours after cesarean section under general anesthesia and improve postoperative analgesia comfort.
引文
[1] Blanco R,Ansari T,Girgis E. Quadratus lumborum block for postoperative pain after caesarean section:A randomised controlled trial[J]. Eur J Anaesthesiol,2015,32(11):812-818.DOI:10. 1097/EJA. 0000000000000299.
[2] Devroe S,Van de Velde M,Rex S. General anesthesia for caesarean section[J]. Curr Opin Anaesthesiol,2015,28(3):240-246.DOI:10. 1097/ACO. 0000000000000185.
[3] Tafish R,KIA EA,Madi W. General versus spinal anaesthesia for caesarean section:a quasi-controlled trial[J]. Lancet,2018,391Suppl 2:S33. DOI:10. 1016/S0140-6736(18)30399-4.
[4] Lalmand M,Wilwerth M,Fils JF,et al. Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia:A Prospective, Randomized Controlled,Double-Blind Study[J]. Anesth Analg,2017,125(3):907-912. DOI:10. 1213/ANE. 0000000000001892.
[5] Katz D,Beilin Y. Disorders of coagulation in pregnancy[J]. Br J Anaesth,2015,115 Suppl 2:ii75-88. DOI:10. 1093/bja/aev374.
[6] Tolcher MC,Chu DM,Hollier LM,et al. Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia[J]. Am J Obstet Gynecol,2017,217(3):365. e1-365. e8.DOI:10. 1016/j. ajog. 2017. 04. 035.
[7] Le Fevre ML; U. S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia:U. S. Preventive Services Task Force recommendation statement[J]. Ann Intern Med,2014,161(11):819-826. DOI:10. 7326/M14-1884.
[8] Fechner J,Ihmsen H,Schüttler J,et al. The impact of intra-operative sufentanil dosing on post-operative pain,hyperalgesia and morphine consumption after cardiac surgery[J]. Eur J Pain,2013,17(4):562-570. DOI:10. 1002/j. 1532-2149. 2012.00211. x.
[9] Carvalho B,Mirza F,Flood P. Patient choice compared with no choice of intrathecal morphine dose for caesarean analgesia:a randomized clinical trial[J]. Br J Anaesth,2017,118(5):762-771. DOI:10. 1093/bja/aex039.
[10] Lalmand M,Wilwerth M,Fils JF,et al. Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia:A Prospective, Randomized Controlled,Double-Blind Study[J]. Anesth Analg,2017,125(3):907-912. DOI:10. 1213/ANE. 0000000000001892.
[11] El AKA,Tafish R,Zourob H. Morphine versus fentanyl for spinal post-caesarean analgesia:a randomised controlled trial[J]. Lancet,2018,391 Suppl 2:S20. DOI:10. 1016/S0140-6736(18)30386-6.
[12] Abdallah FW,Halpern SH,Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis[J]. Br J Anaesth,2012,109(5):679-687. DOI:10. 1093/bja/aes279.
[13] Blanco R,Ansari T,Girgis E. Quadratus lumborum block for postoperative pain after caesarean section:A randomised controlled trial[J]. Eur J Anaesthesiol,2015,32(11):812-818.DOI:10. 1097/EJA. 0000000000000299.
[14]张隆盛,林旭林,张欢楷,等.超声引导腰方肌阻滞对剖宫产术后镇痛的影响[J].河北医科大学学报,2018,39(9):1053-1057. DOI:10. 3969/j. issn. 1007-3205. 2018. 09. 014.
[2] Devroe S,Van de Velde M,Rex S. General anesthesia for caesarean section[J]. Curr Opin Anaesthesiol,2015,28(3):240-246.DOI:10. 1097/ACO. 0000000000000185.
[3] Tafish R,KIA EA,Madi W. General versus spinal anaesthesia for caesarean section:a quasi-controlled trial[J]. Lancet,2018,391Suppl 2:S33. DOI:10. 1016/S0140-6736(18)30399-4.
[4] Lalmand M,Wilwerth M,Fils JF,et al. Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia:A Prospective, Randomized Controlled,Double-Blind Study[J]. Anesth Analg,2017,125(3):907-912. DOI:10. 1213/ANE. 0000000000001892.
[5] Katz D,Beilin Y. Disorders of coagulation in pregnancy[J]. Br J Anaesth,2015,115 Suppl 2:ii75-88. DOI:10. 1093/bja/aev374.
[6] Tolcher MC,Chu DM,Hollier LM,et al. Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia[J]. Am J Obstet Gynecol,2017,217(3):365. e1-365. e8.DOI:10. 1016/j. ajog. 2017. 04. 035.
[7] Le Fevre ML; U. S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia:U. S. Preventive Services Task Force recommendation statement[J]. Ann Intern Med,2014,161(11):819-826. DOI:10. 7326/M14-1884.
[8] Fechner J,Ihmsen H,Schüttler J,et al. The impact of intra-operative sufentanil dosing on post-operative pain,hyperalgesia and morphine consumption after cardiac surgery[J]. Eur J Pain,2013,17(4):562-570. DOI:10. 1002/j. 1532-2149. 2012.00211. x.
[9] Carvalho B,Mirza F,Flood P. Patient choice compared with no choice of intrathecal morphine dose for caesarean analgesia:a randomized clinical trial[J]. Br J Anaesth,2017,118(5):762-771. DOI:10. 1093/bja/aex039.
[10] Lalmand M,Wilwerth M,Fils JF,et al. Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia:A Prospective, Randomized Controlled,Double-Blind Study[J]. Anesth Analg,2017,125(3):907-912. DOI:10. 1213/ANE. 0000000000001892.
[11] El AKA,Tafish R,Zourob H. Morphine versus fentanyl for spinal post-caesarean analgesia:a randomised controlled trial[J]. Lancet,2018,391 Suppl 2:S20. DOI:10. 1016/S0140-6736(18)30386-6.
[12] Abdallah FW,Halpern SH,Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis[J]. Br J Anaesth,2012,109(5):679-687. DOI:10. 1093/bja/aes279.
[13] Blanco R,Ansari T,Girgis E. Quadratus lumborum block for postoperative pain after caesarean section:A randomised controlled trial[J]. Eur J Anaesthesiol,2015,32(11):812-818.DOI:10. 1097/EJA. 0000000000000299.
[14]张隆盛,林旭林,张欢楷,等.超声引导腰方肌阻滞对剖宫产术后镇痛的影响[J].河北医科大学学报,2018,39(9):1053-1057. DOI:10. 3969/j. issn. 1007-3205. 2018. 09. 014.