| Objective:To study the postoperative analgesic effect of ultrasound-guided transverse abdominal muscle plane block combined with nalbuphine after cesarean section.Methods:Approved by the Medical Ethics Committee of Yanbian University,100 patients,aged 20-35 years old,were selected for cesarean section under elective spinal-epidural anaesthesia in the Affiliated Hospital of Yanbian University from June 2019 to December 2019.The grades are Ⅰ-Ⅱ according to American Society of Anesthesiologists(ASA),and the patients were di-vided into groups A,B,C,and D according to a random number table with 25 cases in each group.Patients in group A received ultrasound-guided bi-lateral transverse abdominal muscle plane block(TAPB)(0.5%ropivacaine 15ml on each side)combined with patient-controlled intravenous analgesia(PCIA)(sufentanil 1μg·kg-1·100 mL-1).Patients in group B received ultra-sound-guided bilateral TPAB(0.5%ropivacaine 15ml on each side)com-bined with PCIA(nalbuphine 1.5mg·kg-1·100 mL-1)after surgery.Patients in group C received PCIA analgesia(sufentanil 1 μg·kg-1·100 mL-11)after sur-gery.Patients in group D received PCIA analgesia(nabuphine 1.5 mg·kg-1·100 mL-1)after surgery.Before the operation,fasting is routinely required.After she enters into the operation room,the peripheral venous channel is opened,and the electrocardiogram,heart rate,pulse oximetry,and non-inva-sive blood pressure are monitored throughout the operation.At the beginning of anaesthesia,the parturient was punctured vertically in the L3-4 space in the lateral position,and then entered the subarachnoid space to withdraw the cerebrospinal fluid smoothly,and then injected iso gravity bupivacaine 2ml(0.75%bupivacaine 1.5 ml+ cerebrospinal fluid 0.5 ml).Insert the epidural catheter 3cm to the cephalic side.After the catheter is fixed,the parturient takes the supine position and tilts the operating bed 15°-30° to the left to prevent hypotension syndrome in the supine position.Adjust the level of anaesthesia at the T6-T8 level,and maintain hemodynamic stability by using vasoactive drugs such as phenylephrine or adjusting the infusion rate.Eval-uate and record the resting visual analogue scale(VAS)and the moving vis-ual analogue scale(MVAS)during functional exercise at 6h(T1),12h(T2),24h(T3),and 48h(T4)respectively.Record the number of additional anal-gesia pumps and the occurrence of adverse reactions after surgery,detect the changes of fasting blood glucose before and after surgery,postoperative white blood cell levels,and the numerical value of postoperative hypersen-sitive C-reactive protein(hsCRP).Result:1.The visual analogue score(VAS)of the four groups of patients at rest showed that:compared with groups A,C,and D,the VAS scores of group B were lower than the other three groups at the same time point,and all were statistically significant(P<0.05).Compared with group C,group D had a lower VAS score at rest at the same time point,and it was statistically sig-nificant(P<0.05)2.The visual analogue score(VAS)of the four groups of patients during active functional exercise showed that compared with the three groups of groups A,C,and D,and the VAS scores of group B were lower during active functional exercise at the same time point,and all were statistically signifi-cant(P<0.05).3.The number of additional analgesic pumps at 48 hours after operation showed that groups C and D have higher numbers than that in groups A and B,and the difference was statistically significant(P<0.05).4.The comparison of the white blood cell re-examination of the four groups of patients at 48 hours after the operation showed that there was no signifi-cant difference in the white blood cell re-examination results of the four groups of patients in groups A,B,C and D at 48 hours after the operation(P>0.05).5.The results of 48h postoperative hypersensitivity C-reactive protein showed that there was no significant difference between groups A and B,while the hypersensitivity C-reactive protein of groups A and B were lower than those of groups C and D,and the difference was statistically significant(P<0.05)6.The results of the preoperative and postoperative fasting blood glucose changes of the four groups of patients showed that there was no significant difference in the preoperative fasting blood glucose of the four groups of patients(P>0.05).The comparison of postoperative fasting blood glucose between groups showed that groups C and D were higher than groups A and B,and the difference was statistically significant(P<0.05).7.The results of the comparison of adverse reactions after surgery showed that there was 1 patient with itchy skin and 2 patients with nausea and vom-iting in group A,3 patients with nausea and vomiting in group C,and no adverse reactions in group B and D.Conclusion:The ultrasound-guided lower transverse abdominal muscle plane block combined with intravenous self-controlled nalbuphine pumping can provide better analgesia for acute pain after cesarean section and pro-mote rapid postoperative recovery. |
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