PDF(Pubmed)
Abstract：
Spinal and epidural blocks are commonly employed for pain relief during and following cesarean section. Intrathecal morphine (ITM) has been the gold standard for the same for many years. In recent times, many peripheral nerve blocks (PNBs) have been tried for postoperative analgesia following cesarean delivery (PACD). This article has reviewed the common PNBs used for PACD. The role of PNBs along with ITM has been studied and the current best strategy for PACD has also been explored. Currently, Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine have been found to be the most effective strategy, providing lower rest pain at 6 hours as compared to ITM alone. In patients not receiving intrathecal morphine, recommended PNBs are lateral transversus abdominis plane block, single shot local anesthetic wound infiltration, or continuous wound infiltration with catheter below rectus fascia. PNBs are recommended for PACD. They have an opioid-sparing effect and are devoid of adverse effects associated with central neuraxial blocks such as hypotension, bradycardia, and urine retention. However, caution must be observed with PNBs for possible local anesthetic toxicity due to the large volumes of drug required.
摘要：
脊柱和硬膜外阻滞通常用于在剖宫产期间和之后缓解疼痛。鞘内注射吗啡（ITM）多年来一直是相同的黄金标准。最近,许多外周神经阻滞(PNBs)已尝试用于剖宫产(PACD)术后镇痛.本文回顾了用于PACD的常见PNB。研究了PNB与ITM的作用，并探索了PACD的当前最佳策略。目前,已经发现髂腹股沟神经和腹前横肌平面阻滞联合鞘内注射吗啡是最有效的策略。与单独的ITM相比，在6小时提供更低的休息疼痛。在未接受鞘内注射吗啡的患者中，推荐的PNB是腹横肌平面阻滞，单次注射局部麻醉伤口浸润，或使用直肌筋膜下的导管持续浸润伤口。PNB建议用于PACD。它们具有阿片类药物保护作用，并且没有与中枢神经传导阻滞相关的不良反应，如低血压，心动过缓,和尿潴留。然而,由于需要大量的药物，必须谨慎观察PNB可能的局部麻醉毒性。
