摘要目的 观察腹腔反式入路法行腹横肌平面(TAP)阻滞用于剖宫产术后镇痛的效果.方法 选择ASA Ⅰ～Ⅱ级、行初次剖宫产术的产妇40例,随机数字表法分成A、B两组,每组20例,均常规行蛛网膜下腔阻滞.A组在关闭腹腔前,从腹腔内用22 G针头行双侧TAP阻滞(在腋中线平脐水平,0.298％甲磺酸罗哌卡因溶液20 mL);B组给予等量0.9％氯化钠注射液作为对照.术后镇痛全部采用苏芬太尼自控静脉镇痛(PCIA).观察两组患者在2、4、8、24 h的视觉模拟疼痛(VAS)评分以及苏芬太尼的用量和不良反应.结果 与B组比较,A组在2、4h两个时间点的VAS评分显著降低(P＜0.05),两组8、24 h VAS评分差异无统计学意义(P＞0.05);A组苏芬太尼用量明显减少(P＜0.01);两组不良反应发生率:恶心呕吐(15％比25％)、皮肤瘙痒(5％比20％)、头晕(0％比10％),两组差异均有统计学意义(均P＜0.05).结论 腹腔反式入路法腹横肌平面阻滞用于剖宫产术后镇痛效果确实.

abstractsObjective To observe the effect of postoperative analgesia for cesarean section with a new approach to transversus abdominis plane block.Methods 40 ASA physical status Ⅰ to Ⅱ patients undergoing cesarean section firstly were rucruited.All the patients were randomly divided into the two groups,20 cases in each group.A standard subarachnoid block was used.Group A:TAP block was performed at the end of surgery by piercing the transversus abdominis muscle from inside the abdominal wall at the midaxillary line at the level of the umbilicus with a 22-gauge blunt needle.The patients were assigned to receive 20mL of 0.298％ ropivacaine on each side of the abdominal wall.Group B:the patients were also assigned to receive normal saline.Sufentanil was used for postoperative analgesia by PICA.Each patient was assessed at 2,4,8,24 hours postoperatively using a visual analog scale,the dosage of analgesic drug and the adverse reactions.Results Compared with group B,group A had significantly lower pain scores at 2,4 hours using a visual analog scale (P ＜ 0.05) and there were no significant differernces in 8,24 hours(P ＞ 0.05).The cumulative sufentanil requirement of group A was also significantly lower at all time points (P ＜ 0.01).The incidence of sedation of the two groups were also significant differernces,eg.nausea and vomiting (15％/25％),itchy skin(5％/20％),dizziness(0/10％) (P ＜ 0.05).Conclusion This new approach to transversus abdominis plane block provides effective postoperative analgesia after cesarean section.