背景:改善剖宫产术后疼痛控制仍然是一个具有挑战性的目标。尽管据报道,与安慰剂相比,剖腹产后侧方肌阻滞和针灸可提供更好的术后镇痛效果,这些技术的功效从未进行过正面比较。
目的:本研究旨在研究选择性剖宫产术后腰方阻滞和针刺的镇痛效果。
方法:在此前瞻性中,随机化,对照临床试验,共纳入了190例计划在腰-硬膜外麻醉下进行剖宫产的单胎足月妊娠患者.患者按1:1随机分为针刺组或腰方肌阻滞组。腰方肌外侧阻滞组给予0.33%罗哌卡因双侧腰方肌外侧阻滞加假针刺,针刺组采用经皮穴位电刺激压针治疗和假腰方肌阻滞。所有患者均接受规范的术后疼痛治疗。主要结果是24小时运动时的疼痛评分。次要终点包括术后前48小时的疼痛评分,患者自控静脉镇痛需求,镇痛相关的不良反应,术后并发症,QoR-15,动员时间,和胃肠功能。
结果:在接受针刺或腰方肌外侧阻滞的患者中,运动时24h疼痛评分的中位数(IQR[range])相似(3(2-4)与3(2-4)分别为;P=0.40)。术后48h内患者自控静脉镇痛用量和疼痛评分两组间也无差异。针刺改善术后24h和48h的QoR-15评分(P<0.001),与外侧方肌阻滞相比,缩短了首次排气(P=0.03)和首次饮酒(P<0.001)的时间。此外,与针刺组相比,腰方肌阻滞组的中位动员时间明显延长(17.0(15.0-19.0)hvs.15.3(13.3-17.0)h,估计的中位数差异,1.5;95CI,1-2;P<0.001;)。
结论:作为剖宫产术后多模式镇痛方案的组成部分,与腰方肌外侧阻滞相比,针刺并未降低术后疼痛评分或减少镇痛药物消耗。
BACKGROUND: Improved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head.
OBJECTIVE: This study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section.
METHODS: In this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function.
RESULTS: Median (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2-4] vs 3 [2-4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0-19.0] hours vs 15.3 [13.3-17.0] hours, estimated median difference, 1.5; 95% CI, 1-2; P<.001).
CONCLUSIONS: As a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.