The Analgesic Efficacy of Subarachnoid Morphine in Comparison with Ultrasound-Guided Transversus Abdominis Plane Block After Cesarean Delivery: A Randomized Controlled Trial
The Analgesic Efficacy of Subarachnoid Morphine in Comparison with Ultrasound-Guided Transversus Abdominis Plane Block After Cesarean Delivery: A Randomized Controlled Trial
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DOI：
10.1213/ane.0b013e3181e30b9f
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发表时间：
2010-08-01
影响因子：
5.7
通讯作者：
Siddik-Sayyid, Sahar M.
中科院分区：
文献类型：
--
作者：
Kanazi, Ghassan E.;Aouad, Marie T.;Siddik-Sayyid, Sahar M.
背景：超声引导下腹横肌平面阻滞是缓解剖宫产术后疼痛的有效方法。吗啡是目前治疗剖宫产术后疼痛的“金标准”。在这项研究中，我们测试的假设，蛛网膜下腔吗啡将提供更长的时间和上级镇痛比将腹横肌平面阻滞在接受择期caseorectomy delivery.METHODS：在这项前瞻性，双盲研究，57例患者被随机分配到接受蛛网膜下腔吗啡（SAM组; n = 28）或腹横肌平面阻滞（TAP组; n = 29）。SAM组采用布比卡因复合吗啡0.2mg腰麻，TAP组采用生理盐水腰麻。手术结束后，SAM组用生理盐水行双侧腹横肌平面阻滞，TAP组用0.375%布比卡因加肾上腺素5 μ g/mL行双侧腹横肌平面阻滞，每侧20 mL。术后前24小时的镇痛包括预定的直肠双氯芬酸和IV对乙酰氨基酚;使用IV曲马多治疗爆发性疼痛。在接下来的24小时内，给予计划的直肠双氯芬酸;根据患者要求，给予口服对乙酰氨基酚和IV曲马多。术后在麻醉后监护室（时间0小时）和2、4、6、12、24、36和48小时对患者进行评估。结果：SAM组首次要求镇痛的中位（范围）时间长于TAP组[8（2-36）h vs 4（0.5 - 29）h（P = 0.005）]。SAM组在0 - 12小时之间接受的曲马多剂量的中位数（范围）为0（0-1），TAP组为0（0-2）（P = 0.03）。术后4 h内，SAM组静息和运动时内脏疼痛评分低于TAP组，但在其他时间点无差异。SAM组中重度恶心的发生率高于TAP组[13/28（46%）vs 5/29（17%）（P = 0.02）]。SAM组出现瘙痒需要治疗的患者多于TAP组[（11/28（39%）vs 0（0%）（P < 0.001）]。结论：作为多模式镇痛方案的一部分，蛛网膜下腔吗啡在剖宫产术后提供了比超声引导下腹横肌平面阻滞更上级的镇痛效果，但代价是副作用增加。（Anesth Analg 2010;111：475-81）
BACKGROUND: Ultrasound-guided transversus abdominis plane block is an effective method of providing pain relief after cesarean delivery. Neuraxial morphine is currently the "gold standard" treatment for pain after cesarean delivery. In this study we tested the hypothesis that subarachnoid morphine would provide more prolonged and superior analgesia than would transversus abdominis plane block in patients undergoing elective cesarean delivery.METHODS: In this prospective, double-blind study, 57 patients were randomly assigned to receive either subarachnoid morphine (group SAM; n = 28) or transversus abdominis plane block (group TAP; n = 29). Patients received bupivacaine spinal anesthesia combined with morphine 0.2 mg in group SAM and received saline in group TAP. At the end of surgery, bilateral transversus abdominis plane block was performed using saline in group SAM or using bupivacaine 0.375% plus epinephrine 5 mu g/mL in group TAP with 20 mL on each side. Postoperative analgesia for the first 24 hours consisted of scheduled rectal diclofenac and IV paracetamol; breakthrough pain was treated with IV tramadol. For the next 24 hours, scheduled rectal diclofenac was given; oral paracetamol and IV tramadol were administered upon patient request. Patients were assessed postoperatively in the postanesthesia care unit (time 0 hours) and at 2, 4, 6, 12, 24, 36, and 48 hours. The primary outcome measure was the time to first analgesic request.RESULTS: Median (range) time to first analgesic request was longer in group SAM than in group TAP [8 (2-36) hours versus 4 (0.5 to 29) hours (P = 0.005)]. Median (range) number of tramadol doses received between 0 and 12 hours was 0 (0-1) in group SAM versus 0 (0-2) in group TAP (P = 0.03). Postoperative visceral pain scores at rest and on movement during first the 4 hours were lower in group SAM than in group TAP, but were not different at any other time points. The incidence of moderate to severe nausea was higher in group SAM than in group TAP [13/28 (46%) versus 5/29 (17%) (P = 0.02)]. More patients developed pruritus requiring treatment in group SAM than in group TAP [(11/28 (39%) versus none (0%) (P < 0.001)].CONCLUSION: As part of a multimodal analgesic regimen, subarachnoid morphine provided superior analgesia when compared with ultrasound-guided transversus abdominis plane block after cesarean delivery, yet at the cost of increased side effects. (Anesth Analg 2010;111:475-81)