Effect Of Ultrasound-guided Continuous TAP Block On Postoperative Analgesia,stress Inflammatory Response And Maternal Lactation In Patients Undergoing Cesarean Section

Aim:To investigate the effects of continuous TAP block guided by ultrasound on stress inflammatory response,analgesic effect and maternal lactation after cesarean section.Method:Sixty patients undergoing cesarean section under epidural anesthesia were randomly divided into TAP group and PCIA group,30 cases in each group.Both groups were connected with an electronic analgesic pump for PCIA after operation.The pump was used: sufentanil2.0 ?g/kg plus flurbiprofen ester 150 mg diluted to 100 ml with normal saline,no background dose,single compression dose was 3 ml,lock time 15 min.Ultrasound-guided continuous TAP block was performed in the TAP group.After TAP block puncture,20 ml of 0.25% ropivacaine was administered to each side,followed by continuous administration of 0.2% ropivacaine 6-8 ml/h to 48 h after surgery.The BP,HR,VAS scores and Ramsay sedation scores were recorded at 2,6,12,24,and 48 h after surgery.The cumulative consumption of sufentanil in the analgesic pump and the number of effective compressions of the electronic analgesia pump were recorded during the 48-hour period(D1)and the actual number of compressions(D2),patient satisfaction;The plasma cortisol(Cor)concentration was measured by radioimmunoassay at 12 h,24 h,and 48 h after surgery.ELISA method to detect plasma norepinephrine(NE),interleukin-6(IL-6)at 12 h,24 h,48 h after surgery and the concentration of tumor necrosis factor-?(TNF-?)and serum prolactin concentration at 24 h and 48 h after operation,the postpartum colostrum time was recorded,and the breastfeeding rate was calculated 48 hours after delivery.The plane changes of postoperative TAP block and related complications(hematoma at the puncture site,infection,severe abdominal wall injury,and local anesthetic poisoning)were recorded.Result:1.Twenty-nine patients in the final TAP group and 30 patients in the PCIA group completed the study.2.Compared with the TAP group,BP and HR increased in the PCIA group at 6h and12 h,but there was no statistical difference between both of the groups(P>0.05).3.The VAS scores of the TAP group were lower than those of the PCIA group at 6h and 12 h after operation(P<0.05).The cumulative consumption of sufentanil,analgesic remediation rate,and nausea and vomiting 24 h after operation in the TAP group within 48 hours after operation.The incidence was significantly less than that of the PCIA group(P<0.05).4.D1/D2 and patient satisfaction in the TAP group were significantly higher than those in the PCIA group,and there was no statistical difference between the two groups(P<0.05).5.The levels of NE,Cor,IL-6 and TNF-? in the TAP group were lower than those in the PCIA group at 12 h,24 h and 48 h after operation(P<0.05).6.The colostrum time in the TAP group was significantly shorter than that in the PCIA group.The breastfeeding rate in the TAP group was significantly higher than that in the PCIA group at 48 hours postpartum(P<0.05).The serum prolactin concentration at 24 h and 48 h after TAP was significantly higher than that in PCIA group(P<0.05).7.Continuous TAP block plane was relatively fixed 48 h after surgery(T10-L1),and no complications related to TAP block were observed.Conclusion:Ultrasound-guided continuous TAP block can improve the analgesic effect after maternal cesarean section,reduce the dosage of opioids and related adverse reactions,reduce postoperative stress response,reduce the release of inflammatory cytokines,and promote maternal lactation as soon as possible.To improve the success rate of breastfeeding and patient satisfaction,it can be used as an option for postoperative multimodal analgesia.