Efficacy of transversus abdominis plane block combined with butopenol PCIA for analgesia after cesarean section under general anesthesia / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the efficacy of transversus abdominis plane (TAP) block combined with butopenol patient-controlled intravenous analgesia (PCIA) for analgesia after cesarean section under general anesthesia.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients,aged 18-42 yr,weighing 52-88 kg,at 38-42 weeks of gestation,scheduled for elective cesarean section under general anesthesia,were divided into 3 groups (n=30 each) using a random number table method:TAP block group (group TAP),butopenol PCIA group (group B) and TAP block plus butopenol PCIA group (group TB).In group TAP,bilateral TAP blocks were performed under ultrasound guidance at the end of surgery,and 0.375％ ropivacaine 20 ml was injected into each side.In group B,butopenol 1 mg was intravenously injected at 30 min before the end of operation,PCIA was performed at the end of surgery,PCIA solution contained butopenol 8 mg and ondansetron 8 mg (diluted to 100 ml in sodium chloride injection),and the PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Butopenol 1 mg was intravenously injected at 30 min before the end of operation,and TAP block in combination with butopenol PCIA was performed at the end of operation in group TB.When the postoperative visual analog scale score was greater than or equal to 4 points,morphine 10 mg was intramuscularly injected as rescue analgesic.The requirement for morphine was recorded within 48 h after operation.The occurrence of agitation during emergence from anesthesia and adverse reactions within 48 h after operation were also recorded.Results No adverse reactions such as hematoma at the puncture site or local anesthetic intoxication were observed in TAP group and TB group.Compared with group TAP,the incidence of postoperative shivering and requirement for morphine were significantly decreased in group TB (P＜0.05).The incidence of postoperative nausea and v omiting and requirement for morphine were significantly lower in group TB than in group B (P＜0.05).Conclusion The combination of TAP block and butopenol PCIA exerts better efficacy for analgesia after cesarean section under general anesthesia than either alone.