Efficacy Of Multimodal Analgesia Of Transversus Abdominis Plane Block Combined With Patient-controlled Intravenous Analgesia For Postoperative Analgesia In Cesarean Delivery Under General Anesthesia

Objective:To observe the efficacy of multimodal analgesia of transversus abdominis plane(TAP)block combined with patient-controlled intravenous analgesia(PCIA)for postoperative analgesia in elective cesarean delivery under general anesthesia.Methods:From December 2016 to August 2017,in Jiaxing Maternity and Child Health Care Hospital,Sixty ASA?-?patients scheduled for elective caesarean delivery under general anesthesia were randomly divided into 2 groups with 30 in each.The ultrasound-guided bilateral TAP block was performed at the end of surgety,and 0.25%ropivacaine 20ml was injected each side in multimodal analgesia group(group?:TAPB combined with PCIA),while the equal voume of normal saline was given in PCIA group(group?).The patients received PCIA.The visual analogue scores(VAS)at rest and movement recored at2,6,12,24 and 48h after operation.The time to require the first bolus,compresssin numbers,the overall satisfaction scores on analgesia and consumption of PCIA within 24h after operation were recored.The level of sedation was evaluated with Ramsay sedation score.The time of gastrointestinal ventilation,the indwelling time of catheter and the time of hospitalization were recorded in the two groups.The postoperative nausea and vomiting,chills,skin itching,respiratory depression and other adverse reactions were also recored.Results:VAS scores at rest were no statistically significant differences in both the groups(P>0.05).Compared with group?,VAS scores at movement were significantly decreased at 2,6,12 and 24 h after operation in group?(t=4.36,4.83,5.09,3.01,P<0.05 or P<0.01).Compared with group?,the time to require the first bolus after operation was significantly longer(12.2±5.0 vs 3.9±2.2,t=6.71,P<0.05),compression numbers within 24 h after operation were less(2.1±1.4 vs 6.3±2.5,t=6.08,P<0.01),and the overall satisfaction scores on analgesia were increased in group?(93%vs 73%,?~2=4.32,P<0.01),and the consumption of PCIA within 24 h after operation were significantly lower(50.2±2.4 vs61.4±6.0,t=6.71,P<0.05).Ramsay sedation scores were no statistically significant differences in both the groups(P>0.05).TAP block-related complications were not found in both groups.There was no significant difference between both groups in incidence rates of nausea,vomiting,pruritus,respiratory depression and urine detention(P>0.05).Conclusion:Multimodal analgesia of TAP block combined with PCIA can reduce the requirement of analgesics during PCIA,enhance the efficacy of postoperative analgesia,and increase satisfaction scores on analgesia in elective caesarean delivery under general anesthesia.