蛛网膜下腔阻滞与超声引导腹横肌筋膜平面阻滞在剖宫产术中的应用：随机、双盲、安慰剂对照试验
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蛛网膜下腔阻滞与超声引导腹横肌筋膜平面阻滞在剖宫产术中的应用：随机、双盲、安慰剂对照试验
翻译：牛振瑛 编辑：冯玉蓉 审校：曹莹
背景：剖宫产术后，产妇的舒适度对新手妈妈照顾婴儿至关重要。术后疼痛缓解不足可能会延迟开始母乳喂养的时间，此外，这种疼痛还与产后抑郁和慢性疼痛有关。剖宫产术通常采用Pfannenstiel切口，而腹横筋膜平面（TFP）阻滞可在T12和L1节段皮区提供术后镇痛。
目的：研究TFP阻滞对腰麻下剖宫产患者术后阿片类药物消耗和疼痛评分的影响。
设计：随机对照双盲研究。
地点：单中心教学医院
研究对象：60名接受剖宫产的产妇。
干预措施：TFP组(n=30)在超声引导下用0.25%布比卡因20ml行双侧TFP阻滞。对照组（n=30）注射生理盐水20ml。术后每6h静脉注射扑热息痛1g，并采用患者吗啡自控镇痛（PCA）。
主要结果指标：观察两组患者术后视觉模拟疼痛评分、吗啡用量、紧急镇痛及阿片类药物相关不良反应。
结果：TFP组术后2h静息视觉模拟疼痛评分（P=0.011）以及术后2、4、8h活动时的疼痛评分（P分别为0.014、<0.001和0.032）明显低于对照组。对照组术后24h吗啡用量显著高于TFP组(分别为38.5±11.63mg和19.5±8.33mg.P<0.001)。对照组术后恶心、便秘发生率明显高于TFP组(P<0.05)。TFP组患者满意度明显高于对照组(P=0.027)。
结论：术后TFP阻滞可减少阿片类药物的消耗量，缓解腰麻下剖宫产后的急性疼痛。
原始文献来源：Aydin ME, Bedir Z, Yayik AM, et,al.Subarachnoid block and ultrasound-guided transversalis fascia plane block for caesarean section：A randomised, double-blind, placebo-controlled trial[J].Eur J Anaesthesiol 2020 Sep;379(9)DOI：10.1097/EJA.0000000000001222
Subarachnoid block and ultrasound-guided transversalis fascia plane block for caesarean section：A randomised, double-blind, placebo-controlled trial
BACKGROUND After caesarean section, maternal postoperative comfort is critical to allow the new mother to care for her baby. Insufficient pain relief during the postoperative period may delay maternal/infant bonding and, in addition, such pain has been linked to subsequent depression and chronic pain. Caesarean section is commonly performed with a Pfannenstiel incision, and a transversalis fascia plane (TFP) block provides postoperative analgesia in the T12 and L1 dermatomes.
OBJECTIVE The aim of this study was to investigate the effect of the TFP block on postoperative opioid consumption and pain scores in patients undergoing caesarean section under spinal anaesthesia.
DESIGN A randomised controlled, double-blind study.
SETTINGS Single-centre, academic hospital.
PARTICIPANTS Sixty patients undergoing caesarean section.
INTERVENTIONS The TFP group (n=30) received an ultrasound-guided bilateral TFP block with 20 ml of 0.25% bupivacaine. The control group (n=30) received 20 ml of saline bilaterally. Postoperative analgesia was given every 6 h with intravenous paracetamol 1 g and patient-controlled analgesia (PCA) with morphine.
MAIN OUTCOME MEASURES Postoperative visual analogue pain scores, morphine consumption, rescue analgesia and opioid-related side effects were evaluated.
MAIN OUTCOME MEASURES Postoperative visual analogue pain scores, morphine consumption, rescue analgesia and opioid-related side effects were evaluated.
RESULTS In the TFP group, the visual analogue pain scores were significantly lower at rest for 2h after the operation (P=0.011) and during active movement at 2, 4 and 8 h postoperatively (P=0.014, <0.001 and 0.032, respectively).Morphine consumption in the first 24h after surgery was significantly higher in the control group compared with the TFP group (38.5±11.63 and 19.5±8.33 mg, respectively;P<0.001). The incidence of postoperative nausea and constipation were statistically higher in the control group than in the TFP group (P<0.05). Patient satisfaction was significantly higher in the TFP group (P=0.027).
CONCLUSION A postoperative TFP block can reduce opioid consumption and relieve acute pain after a caesarean section under spinal anaesthesia.
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