Application Of Ilioinguinal-transversus Abdominis Plane (I-TAP) Nerve Block In Cesarean Section Anesthesia

Experiment 1Objective: To compare the effects of ilioinguino-transverse abdominis plane(I-TAP)block and transverse abdominis plane(TAP)block on postoperative analgesic effect and postoperative recovery quality after cesarean section.Methods: 60 cases of ASA grade I or II,aged 18-35,150-170 cm in height,70-90 kg in weight,selected for cesarean section under combined spinal and epidural anesthesia were divided into I-TAP group and TAP group according to random number table method,with 30 cases in each group.I-TAP group underwent bilateral I-TAP block guided by ultrasound after surgery,and 0.33% ropivacaine 30 ml was given on each side;The women in the TAP group received bilateral TAP block guided by ultrasound after surgery,and 0.33% ropivacaine was given 30 ml on each side.The usage of sufentanil at 1h,4h,8h,16 h and 24 h after obstetrics was recorded in the two groups.The VAS scores at rest and exercise and the number of pressing of PCA pump were recorded.The maternal satisfaction and the occurrence of postoperative adverse reactions were recorded.Results: At 1h after surgery,there was no significant difference in the amount of sufentanil and the number of PCA compressions between the two groups(P>0.05),and the amount of sufentanil and the number of pressing PCA in HI-TAP group at 4h,8h,16 h and 24 h postoperatively were significantly lower than those in TAP group,the difference was statistically significant(P< 0.05)There was no significant difference in VAS scores at rest and exercise 1h after gynecology between the two groups(P> 0.05),and the resting and exercise VAS scores of the HI-TAP group at 4h,8h,16 h and 24 h postoperatively were lower than those of the TAP group,the difference was statistically significant(P< 0.05)there was no significant difference in postoperative satisfaction and incidence of adverse reactions between the two groups,and the difference was not statistically significant(P> 0.05).Conclusion: After cesarean section,ultrasound-guided I-TAP block has better analgesic effect than TAP block,and has more satisfactory clinical effect.Experiment 2Objective: To investigate the clinical effect and safety of ultrasound-guided I-TAP block before cesarean section,and to provide clinical theoretical and practical basis for the application of this method in general anesthesia for cesarean section.Methods: 60 women(ASA I or II,age 18-35,height 150-170 cm,weight: 70-90kg)who underwent cesarean section under combined epidural anesthesia were selected as the subjects of this study.According to random number table method,they were divided into experimental group(I-TAP group)and control group(C group),with 30 cases in each group.Among them,the I-TAP group was subjected to bilateral I-TAP block under ultrasound guidance before anesthesia,and 0.33% ropivacaine was given 30 ml on each side.Group C was the blank control group.The amount of sufentanil used in the two groups at 1h,4h,8h,16 h and 24 h after obstetrics was recorded.VAS scores at rest and during exercise and the number of pressing of PCA pumps were recorded.Apgar scores at 1min,5min and 10 min after birth were recorded.The Maternal satisfaction、 occurrence of postoperative adverse reactions and intraoperative dosage of ephedrine were recorded.MAP HR was recorded at T0(entry)T1(1min after I-TAP block)T2(skin cutting)T3(delivery of fetus)and T4(exit).Results: There was no significant difference between the two groups in the amount of sufentanil used at rest and the VAS scores at exercise 1h after obstetrics(P> 0.05),and at 4h,8h,16 h and 24 h after surgery,the VAS scores of sufentanil usage in I-TAP group were lower than those in C group at rest and exercise,the difference was statistically significant(P<0.05)At 1h after operation,there was no significant difference in the pressing times of PCA pump between the two groups(P> 0.05),and at4 h,8h,16 h and 24 h after surgery,the pressing times of PCA in I-TAP group were significantly less than those in control group,and the difference was statistically significant(P< 0.05)There was no significant difference in the Maternal satisfaction 、incidence of postoperative adverse reactions and intraoperative amount of ephedrine between the two groups,and the difference was not statistically significant(P> 0.05)There were no significant differences in neonatal score and p H BE at 1min,5min and10 min after birth between the two groups(P> 0.05)Intra-group comparison of MAP at different time points in obstetrics between the two groups: the MAP in I-TAP group was significantly decreased at T1,T2 and T3 compared with T0,and the difference was statistically significant(P< 0.05);Comparison between groups: MAP at T1,T2 and T3 was significantly lower than that in group C,and the difference was statistically significant(P< 0.05)Intra-group comparison of HR at different time points in obstetrics between the two groups: HR at T1,T2 and T3 in I-TAP group was significantly lower than that at T0,and the difference was statistically significant(P<0.05)Comparison between groups: HR in I-TAP group was decreased at T1,T2 and T3 compared with that in C group,and the difference was statistically significant(P< 0.05)Conclusion: Bilateral I-TAP block under ultrasonic guidance before lumbar epidural anesthesia in cesarean section can improve the analgesic effect after gynecology and obstetrics,and the maternal hemodynamics is stable during the operation,and there is no significant effect on the maternal and newborn,which has a certain clinical safety application effect,and provides a clinical practice basis for I-TAP block for cesarean section under general anesthesia.