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| Efficacy of three different analgesic methods for postoperative analgesia in patients undergoing cesarean section |
| DU Penghui1 YANG Shengfeng2 WANG Zhenggang3 CHEN Chunyi3 FENG Xiaobo3▲ |
1.Department of Obstetrics and Gynecology, Wuhan Hospital of China University of Geosciences, Hubei Province, Wuhan 430074, China;
2.Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guizhou Province, Guiyang 550004, China;
3.Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Hubei Province, Wuhan 430071, China |
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Abstract Objective To evaluate the efficacy of three different analgesic methods when used for postoperative analgesia in patients undergoing cesarean section. Methods A total of 90 parturients scheduled for elective cesarean section in Zhongnan Hospital of Wuhan University, from March to December 2017 were selected as research subjects. All parturients underwent cesarean delivery under combined spinal and epidural anesthesia. They were divided into patient-controlled epidural analgesia group (PCEA group), patient-controlled intravenous analgesia group (PCIA group) and continuous transversus abdominis plane block group (CTAP group) according to the random number table method, with 30 cases in each group. In PCEA group, the patients received PCEA with 0.375% Ropivacaine 2 mL after surgery, and the PCEA pump was set up to deliver a 2 mL bolus dose, a 15 min lockout interval and background infusion at a rate of 2 mL/h. In PCIA group, the patients received PCIA with Sufentanil 1 μg/mL + Tropisetron 50 μg/mL mixture 2 mL after surgery, and the PCIA pump was set up to deliver a 2 mL bolus dose, a 15 min lockout interval and background infusion at a rate of 2 mL/h. In CTAP group, bilateral TAP block was performed with 0.375% Ropivacaine 20 mL under ultrasound guidance and 0.375% Ropivacaine 6-8 mL/h was infused into bilateral TAPs by pump after surgery, the pump was set up to deliver a 6-8 mL bolus dose, a 60 min lockout interval. Analgesia lasted until 72 h after operation in all groups. When resting visual analog scale (VAS) scores≥4, Tramadol 100 mg was injected intravenously as rescue analgesia. The resting and moving VAS and Bruggrmann comfort scale (BCS) scores were recorded at immediately after the end of operation and at 2, 6, 12, 24, 36, 48, 72 hours after operation, the rate of rescue analgesia, dosage of Tramadol, the recovery time of postoperative intestinal function and lower limb motor function, and the incidence of adverse reactions were also recorded within 72 h after operation. Results Compared with PCIA group, the resting and moving VAS scores were lower and the BCS scores were higher at 6, 12, 24, 36, 48 hours after operation in PCEA group and CTAP group, the differences were statistically significant (P ＜ 0.05), and the rate of rescue analgesia, dosage of Tramadol, recovery time of postoperative intestinal function and the incidence of adverse reactions were lower in PCEA group and CTAP group, the differences were statistically significant (P ＜ 0.05). There were no significant differences in moving VAS scores, BCS scores, rate of rescue analgesia, dosage of Tramadol, recovery time of postoperative intestinal function and the incidence of adverse reactions between the PCEA group and the CTAP group (P ＞ 0.05), but the recovery time of lower limb motor function in CTAP group was less than that in PCEA group (P ＜ 0.05). Conclusion Compared with PCIA and PCEA, CTAP can provide a better obstetric analgesia and less incidence of adverse reactions when used for the patients undergoing cesarean section, and the complication of CTAP is least.
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[1] 阮焱，张为远.剖宫产的现状及剖宫产率高居不下的原因[J].实用妇产科杂志，2015，31（4）：241-243.
[2] 杨菊华，庞汝彦，钱军程，等.畸高的中国剖宫产率：问题与对策[J].人口与发展，2012，18（5）：36-51.
[3] Andziak M，Beta J，Barwijuk M，et al. Efficacy and tolerability of intravenous morphine patient-controlled analgesia（PCA）in women undergoing cesarean delivery [J]. Ginekol Pol，2015，86（6）：453-456.
[4] Kerai S，Saxena KN，Taneja B. Post-caesarean analgesia：What is new? [J]. Indian J Anaesth，2017，61（3）：200-214.
[5] 雷钟，刘亚华，段惠洁，等.经静脉与硬膜外两种自控镇痛方式效果的系统评价[J].中国循证医学杂志，2009，9（8）：880-886.
[6] 张双银，白洁，高翊博，等.超声引导下连续腹横肌平面阻滞用于子宫全切术患者术后镇痛的效果[J].中华麻醉学杂志，2017，37（8）：951-953.
[7] 占大兴，邹高锐，陈超，等.局部浸润镇痛和腹横肌平面阻滞用于剖宫产术后镇痛的效果比较[J].中国医药导报，2017，14（34）：58-61.
[8] Tikuisis R，Miliauskas P，Lukoseviciene V，et al. Transversus abdominis plane block for postoperative pain relief after hand-assisted laparoscopic colon surgery：a randomized，placebo-controlled clinical trial [J]. Tech Coloproctol，2016，20（12）：835-844.
[9] Nohuz E，El DB，Triki A，et al. Why and how to perform an ultrasound-guided transversus abdominis plane block：A step-by-step approach [J]. Gynecol Obstet Fertil，2016， 44（12）：716-720.
[10] Ripolles J，Marmana MS，Abad A，et al. Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane - a systematic review [J]. Rev Bras Anestesiol，2015，65（4）：255-280.
[11] Eslamian L，Kabiri-Nasab M，Agha-Husseini M，et al. Adding Sufentanil to TAP Block Hyperbaric Bupivacaine Decreases Post-Cesarean Delivery Morphine Consumption [J]. Acta Med Iran，2016，54（3）：185-190.
[12] 侯铁军，陈继恩，陈沛华，等.腰硬联合阻滞、腹横肌平面阻滞在剖宫产术中的应用效果观察[J].山东医药，2015，55（35）：83-84.
[13] Mankikar MG，Sardesai SP，Ghodki PS. Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section [J]. Indian J Anaesth，2016，60（4）：253-257.
[14] Fusco P，Scimia P，Paladini G，et al. Transversus abdominis plane block for analgesia after Cesarean delivery. A systematic review [J]. Minerva Anestesiol，2015，81（2）：195-204.
[15] Mcdonnell JG，O'Donnell BD，Farrell T，et al. Transversus abdominis plane block：a cadaveric and radiological evaluation [J]. Reg Anesth Pain Med，2007，32（5）：399-404.
[16] Maeda A，Shibata SC，Kamibayashi T，et al. Continuous subcostal oblique transversus abdominis plane block provides more effective analgesia than single-shot block after gynaecological laparotomy：A randomised controlled trial [J]. Eur J Anaesthesiol，2015，32（7）：514-515.
[17] Ganapathy S，Sondekoppam RV，Terlecki M，et al. Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery：A randomised，open-label feasibility study [J]. Eur J Anaesthesiol，2015，32（11）：797-804.
[18] Kuthiala G，Chaudhary G. Ropivacaine：A review of its pharmacology and clinical use [J]. Indian J Anaesth，2011，55（2）：104-110.
[19] 张国梁，任燕，孟明华，等.超声引导下连续腹横肌平面阻滞对剖宫产产妇术后镇痛的效果[J].山东医药，2017， 57（37）：84-86.
[20] Pinto FW，Fernandes CR，Vale ML，et al. Evaluation of transversus abdominis plane block in open appendectomy in paediatrics：Comparison of ropivacaine in two different concentrations [J]. Eur J Anaesthesiol，2018，35（7）：547-548.
[21] Mittal T，Dey A，Siddhartha R，et al. Efficacy of ultrasound-guided transversus abdominis plane（TAP）block for postoperative analgesia in laparoscopic gastric sleeve resection：a randomized single blinded case control study [J]. Surg Endosc，2018，32（12）：4985-4989.
[22] 秦朝生.超声引导下连续腹横肌平面阻滞在腹腔镜结直肠手术术后镇痛的效果[D].南宁：广西医科大学，2016. |
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