Abstract:

Objective　To investigate the analgesia effect of different concentrations of sulfentanyl combined with transverse abdominis plane block after cesarean section. Methods　A total of 150 women taking elective cesarean section under intravertebral anesthesia in Shenzhen Hospital (Futian), Guangzhou University of Traditional Chinese Medicine between January 2020 and June 2021 were selected, and they were 21-35 years old and 151-169 cm tall and of American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ and weighed 54-75 kg. They were divided into group A, group B, and group C by the random number table method, taking patient controlled intravenous analgesia with 0.25, 0.50, 1.00 μg/ml sulfentanyl respectively and ultrasound-guided transverse muscle plane block. The Visual Analogue Scale (VAS) scores 2, 4, 8, 12, 24, and 48 h after cesarean section were observed and recorded. How many times the pumps had been pressed and sulfentanyl usage within 48 h were recorded. The incidences of dizziness, nausea and vomiting, skin pruritus, no exhaust, and complications of transverse abdominis plane block after were recorded. Statistics were performed using statistical methods such as one-way ANOVA and chi-square test. Results　There were no statistical differences in the number the pumps had been used and the total sulfentanyl volume between the three groups (all P>0.05). The sulfentanyl usage was (17.59±3.65) μg in group A, was (33.35±6.30) μg in group B, and was (65.39±6.98) μg in group C (F=123.24, P<0.001). There were no statistical difference in the VAS scores at different time points between the three groups (all P>0.05). The incidence of no exhaust was 6.2% (3/48) in group A, 8.5% (4/47) in group B, and 22.4% (11/49) in group C, with the highest in group C (χ²=6.951, P=0.031) and no statistical difference between group A and group B. Conclusion　After transverse abdominis plane block, patient controlled intravenous analgesia with 0.25~0.50 μg/ml sulfentanyl is effective, with a low incidence of adverse reactions.

Key words: Cesarean section, Postoperative analgesia, Transversus abdominis plane block, Sulfentanyl

摘要： 目的　探讨不同浓度舒芬太尼联合腹横肌平面阻滞对剖宫产术后镇痛的效果。方法　选取广州中医药大学深圳医院（福田）2020年1月至2021年6月择期在椎管内麻醉下行剖宫产手术的产妇共150例，年龄21～35岁，身高151～169 cm，体质量54～75 kg，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，采用随机数字表法将其分为A组、B组和C组，分别予0.25 μg/ml、0.50 μg/ml和1.00 μg/ml舒芬太尼行静脉自控镇痛（patient controlled intravenous analgesia，PCIA）联合腹横肌平面（transversus abdominis plane，TAP）阻滞。观察和记录剖宫产术后2、6、12、24、48 h的视觉模拟疼痛（VAS）评分，记录48 h内按泵次数、舒芬太尼使用总体积及总质量；记录镇痛48 h内头晕、恶心呕吐、皮肤瘙痒、未排气、尿潴留和TAP阻滞相关并发症的发生情况。使用单因素方差分析、卡方检验等统计学方法统计数据。结果　3组产妇按泵次数和舒芬太尼总体积比较，差异均无统计学意义（均P>0.05）；A、B和C组舒芬太尼总质量分别为（17.59±3.65）μg、（33.35±6.30）μg、（65.39±6.98）μg，逐渐增多（F=123.24，P<0.001）。3组产妇术后不同时间点的VAS评分差异均无统计学意义（均P>0.05）；A、B和C组未排气的发生率分别为6.2%（3/48）、8.5%（4/47）、22.4%（11/49），与A和B组相比，C组未排气的发生率升高（χ²=6.951，P=0.031），其余不良反应发生率差异均无统计学意义（均P>0.05）。结论　TAP阻滞后PCIA中舒芬太尼浓度为0.25～0.50 μg/ml时镇痛效果好，且不良反应发生率较低。

关键词: 剖宫产, 术后镇痛, 腹横肌平面阻滞, 舒芬太尼