剖宫产术后后内侧腰方肌阻滞与切口局部浸润麻醉的比较:一项随机双盲对照研究

2021
07/17

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减少剖宫产后疼痛和减少阿片类药物使用对促进产妇康复和促进母婴互动至关重要。目前临床上已经实施各种技术以改善镇痛效果。我们比较了后内侧腰方肌阻滞和切口浸润麻醉镇痛效果。


本文由“罂粟花”授权转载


剖宫产术后后内侧腰方肌阻滞与切口局部浸润麻醉的比较:一项随机双盲对照研究


贵州医科大学  高鸿教授课题组

翻译:胡廷菊  编辑:佟睿  审校:曹莹

 
背景  
 

 

减少剖宫产后疼痛和减少阿片类药物使用对促进产妇康复和促进母婴互动至关重要。目前临床上已经实施各种技术以改善镇痛效果。我们比较了后内侧腰方肌阻滞和切口浸润麻醉镇痛效果。

 
目的  
 

 

我们假设在多模式镇痛方法中,与切口浸润麻醉相比,由于腰方肌减轻内脏痛的作用,术后24小时内阿片类药物消耗量减少15%

 
设计  
 

 

一项双盲,随机,安慰剂对照临床研究。

 
范围设置  
 

 

20198月至20205月的单中心研究。

 
受试对象  
 

 

116个产妇随机分为两组,腰方肌组首先以0.9%的生理盐水20ml手术切口注射,然后两侧以0.25%左旋布比卡因20ml行后内侧腰方肌阻滞。在切口浸润组,先以0.25%左旋布比卡因20ml行切口浸润,然后两侧以0.9%的生理盐水20ml行后内侧腰方肌阻滞。

 
主要观察指标  
 

 

主要观察指标是24小时内阿片类药物(哌腈米特)的消耗量。次要观察指标是48小时内哌腈米特的消耗量,首次要求镇痛的时间,静息和运动时的疼痛评分,手术到首次下床活动的时间,手术到首次哺乳的时间,镇静,瘙痒等并发症。

 
结果  
 

 

24小时内哌腈米特的消耗量腰方肌(1.5±1.8mg)组显著少于切口浸润组(2.2±1.7mg)(P=0.04),平均差值为-0.7mg95%CI-1.3-0.03)。在那些需要哌腈米特的病人中,腰方肌组首次要求镇痛的时间11小时(7-14)显著长于局部浸润组7小时(5-11)(P=0.02)。疼痛评分较低,在休息和运动时没有差异。两组在下床行走时间和母乳喂养时间没有差异。

 
结论  
 

 

作为剖宫产后多模式镇痛的一个组成部分,与切口浸润相比,后内侧腰方肌阻滞与24小时阿片消耗量有关。


Posteromedial quadratus lumborum block versus wound infifiltration after caesarean section A randomised, double-blind, controlled study


Abstract

BACKGROUND Reducing pain and minimising opioids after caesarean section are crucial to enhancing maternal recovery and promoting mother-newborn interaction. Various techniques have been implemented to improve analgesia. We compared the analgesic effificacy of posteromedial quadratus lumborum block with that of wound infifiltration following elective caesarean section. 

OBJECTIVE We hypothesised that within a multimodal analgesia approach, posteromedial quadratus lumborum block would, due to its potential to relieve visceral pain, result in a 15% reduction in 24-h postoperative opioid consumption compared with wound infifiltration. 

DESIGN A double-blind, randomised, placebo-controlled clinical study. 

SETTING A single-centre study between August 2019 and May 2020. 

PATIENTS One hundred and sixteen women were randomly allocated into two groups. In the quadratus lumborum group, 20 ml 0.9% saline was injected into the surgical wound followed by bilateral posteromedial quadratus lumborum block using 20 ml 0.25% levobupivacaine per side. In the wound infifiltration group, 20 ml of 0.25% levobupivacaine was injected into the surgical wound followed by a bilateral posteromedial quadratus lumborum injection with 20 ml 0.9% saline per side.  

MAIN OUTCOME MEASURES The primary outcome was opioid (piritramide) consumption at 24 h. Secondary outcomes were piritramide consumption at 48 h, time-to-fifirst analgesic request, pain scores at rest and with movement, surgery-to-fifirst-ambulation time, surgery-to-breastfeeding time, sedation, pruritus and complications. 

RESULTS Piritramide consumption in 24 h was signifificantly lower with posteromedial quadratus lumborum block (1.5 1.8 mg) than with wound infifiltration (2.2 1.7 mg) (P ¼ 0.04), mean difference of -0.7 mg, (95% CI -1.3 to - 0.03). In those who required piritramide, time-to-fifirst analgesic request was signifificantly longer with posteromedial quadratus lumborum block 11 [7 to 14] h, than with wound infifiltration 7 [5 to 11] h (P ¼ 0.02). Pain scores were low, with no differences recorded at rest and with movement. There were no differences in time-to-ambulation and time-tobreastfeed between the groups. 

CONCLUSION As a component of multimodal postcaesarean section analgesia, posteromedial quadratus lumborum block was associated with lower 24-h opioid consumption compared with wound infifiltration. 

TRIAL REGISTRATION ClinicalTrials.gov identififier: NCT04000308 


本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:nanxingjun@hmkx.cn
关键词:
剖宫产术,腰方肌,消耗量,双盲,切口,麻醉,研究,内侧,镇痛

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