关键词:

腹横肌平面阻滞, 艾司氯胺酮, 高龄产妇, 子宫下段剖宫产, 术后镇痛

Abstract:

Objective　To explore the effect of transversus abdominis plane block combined with intravenous esketamine on analgesia after cesarean section in elderly parturients. Methods　A total of 72 parturients who received lower uterine segment cesarean section in Dongguan Maternal and Child Health Hospital from August 2022 to August 2023 were selected for the randomized controlled trial. The included parturients were divided into a control group and an observation group by the random number table method, with 36 cases in each group. The control group were (40.42±9.43) years old; their body mass index was (23.59±7.49) kg/cm². The observation group were (41.91±9.32) years old; their body mass index was (23.62±7.51) kg/cm². Both groups received combined spinal-epidural anesthesia, and ultrasound-guided transversus abdominis plane block was performed in both groups after the operation. The observation group received intravenous injection of esketamine 0.5 mg/kg after the fetuses were delivered. The control group was intravenously injected the same amount of normal saline during the same period. The resting pain scores of Visual Analogue Scale (VAS) of the two groups 2, 4, 6, 12, 24, and 48 h after surgery were recorded. The first patient-controlled analgesia (PCA) times, the total numbers of PCA within 48 h, and the numbers of flurbiprofen axetil rescue analgesia cases were recorded in the two groups. The times of off-bed activities in 48 h and first anal exhaustion times in the two groups were recorded. The occurrences of analgesia-related adverse reactions, such as dizziness and nightmares, in the two groups were recorded. The measurement data of normal distribution were compared between the two group by the independent-sample t test, and the enumeration data by χ² test. Results　The resting pain VAS scores 6 and 12 h after surgery of the observation group were significantly lower than those of the control group [(1.12±0.37) vs. (1.74±0.45) and (1.14±0.38) vs. (1.78±0.47); both P<0.05]. The first PCA time of the observation group was longer than that of the control group [(9.82±1.94) h vs. (5.13±1.47) h; P<0.05]. The total number of PCA in 48 h and the number of flurbiprofen axetil rescue analgesia cases in the observation group were lower than those in the control group [(7.14±1.44) times vs. (10.62±2.92) times and 2.78% (1/36) vs. 25.00% (9/36); both P<0.05]. The times of off-bed activities in 48 h in the observation group was higher than that in the control group [(10.27±2.13) times vs. (8.14±1.68) times; P<0.05]. The first anal exhaustion time in the observation group was shorter than that in the control group [(8.52±1.63) h vs. (12.35±2.41) h; P<0.05]. The incidence of vertigo in the observation group was lower than that in the control group [5.56% (2/36) vs. 27.78% (10/36); P<0.05]. Conclusions　Transversus abdominis plane block combined with intravenous injection of esketamine has significant analgesic effect on elderly parturients after cesarean section; it can reduce postoperative pain VAS score, prolong the first PCA time, reduce the total number of PCA, and promote postoperative recovery.

Key words:

Transversus abdominis plane block, Esketamine, Elderly parturients, Lower uterine segment cesarean section, Postoperative analgesia