| Objective The number of patients in cesarean section has increased year by year.The traditional postoperative analgesia methods are various,but the effect of individual difference is great and early postoperative pain still exists.Transversus abdominis plane block(TAPB)is a new way of analgesia,and it has better effect on abdominal pain.If combined with intravenous analgesia,more satisfactory analgesic effect may be achieved.The aim of this study was to observe the effectiveness and feasibility of bilateral transverse abdominal transverse block combined with intravenous analgesia under ultrasound guidance for early resting and motor state pain management after cesarean section.Methods A total of 70 patients of caesarean section were selected,aged 22 to 40 years old,ASA grade I to II,weight 55 to 80 kg.Informed consent was signed before operation.Random determination of patients' group by envelope method(the envelopes were set according to the ratio of 1:1,and the corresponding serial numbers of the envelopes were opened in order of patients in groups): TAPB group(group T)or control group(group C),35 cases in each group.All operations are completed by subarachnoid anesthesia and intravenous patient-controlled analgesia were connected at the end of the operation(1.2ug/kg sufentanil citrate + 0.25mg/kg dezocine+0.9%NS diluted to 100ml).In group T,bilateral TAPB was performed under ultrasound guidance(0.375% ropivacaine 20 ml each side)at the end of operation.In group C,No special treatment.The analgesic pump was pressed to strengthen the analgesia after the operation.The analgesic effect is still not satisfied and the same time visual analogue scale(VAS)score(0 ~ 10 points,0 for painless,10 to extreme pain)is >6,oral Ibuprofen Sustained-Release Capsules 300 mg for adjuvant analgesia,if the effect is still not satisfied,can be repeated after 6 hours,the daily dosage is not more than 1200 mg.Patientscan eat the liquid diets and attempt breastfeeding after the exhaust,double lower limbs strength reach level 4 or above can get out of bed.The main outcome measures were VAS score and bruggrmann comfort scale(BCS)score(0 for persistent pain,1 were severe in deep breathing or coughing,2 was mild pain in deep breathing or coughing,3 was painless in deep breathing,4 was also painless when coughing)of 2,4,6,12 and 24 h after operation.The secondary outcome measures included the time of the first pressing of the analgesia pump,the number of press times of the intravenous analgesia pump within 12 and 24 hours after operation,the time of the ambulation in the patients,the dosage of auxiliary analgesic drugs,nausea and vomiting,breastfeeding and contractile pain(paroxysmal pain)occur.Results There was no significant difference in general data(including height,weight,age,dosage of anesthetic drugs and operative time)between the two groups.Compared with group C,the VAS scores of group T at 4,6 and 12 hours decreased from 2.9±1.0,3.6±0.9,3.9±0.9 to 1.4±0.7,1.8±0.9,3.0±0.9,and BCS scores increased from 1.5±1.1,0.7±0.8,0.3±0.5 to 2.9±0.7,2.5±0.7,1.1±0.8(P < 0.01).Compared with the C group,there was no significant difference in the time of first pressing intravenous analgesia pump(6.8±3.6)in group T,the frequency of analgesia pump at 12 hours and 24 hours after operation decreased from 7.2±4.7,10.6±6.8 to 3.3±2.0,6.4±5.8(P < 0.05),and the time for the ambulation(27.8±4.5 VS 31.6±4.8)was significantly shortened(P < 0.05).Compared with group C,the incidence of postoperative nausea and vomiting in group T was 8.8%,significantly decreased(P < 0.05),there was no significant difference in the incidence of contractions pain and breastfeeding between the 2 groups(P > 0.05).There were no puncture related complications such as puncture site infection,hematoma and abdominal cavity involvement in the two groups.All the patients did not receive additional analgesic drugs after operation.Conclusion Bilateral transversus abdominis plane block combined with intravenous analgesia can significantly reduce the early pain score after cesarean section,and allow patients to get out of bed earlier.Ultrasound-guided transversus abdominis plane block can be used safely for postoperative pain management in patients undergoing cesarean section. |
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