{"title":"回顾性分析急诊剖腹产手术中外科医生实施的腹横肌平面阻滞。","authors":"Rachel Einarsson, Joshua Knowles","doi":"10.1111/ajo.13871","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post-caesarean section ultrasound-guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment. No previous examination of surgical TAP blocks in patients having undergone emergency caesarean section has been undertaken.</p><p><strong>Aims: </strong>To investigate surgical TAP block and multimodal analgesic use during emergency caesarean section, the effect on surgical time, post-operative analgesia use, and admission length.</p><p><strong>Materials and methods: </strong>We performed a retrospective review of 250 patients who underwent emergency caesarean in 2022. Surgical TAP blocks were performed with 20 mL of 0.375% ropivacaine either side. Primary outcomes included surgical time, length of admission, time to first request of rescue opiate, opiate use in first post-operative 24 h, total dose used during admission, and opiates prescribed on discharge.</p><p><strong>Results: </strong>Ninety-six patients received surgical TAP blocks, and 154 did not. There were no statistically significant differences in the primary outcomes. Subgroup analyses were performed in patients who did not receive intrathecal morphine, body mass index over 30 kg/m<sup>2</sup>, for patients whom this was their first caesarean, and for TAP blocks versus local infiltration to the wound. There were no significant differences in the primary outcomes in these subgroups.</p><p><strong>Conclusions: </strong>Surgical TAP blocks did not prolong surgical time or decrease post-operative analgesia use or admission length in patients having undergone emergency caesarean. Patient-tailored multimodal analgesia is encouraged, although more research is needed.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Retrospective review of surgeon administered transversus abdominis plane blocks at emergency caesarean.\",\"authors\":\"Rachel Einarsson, Joshua Knowles\",\"doi\":\"10.1111/ajo.13871\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post-caesarean section ultrasound-guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment. No previous examination of surgical TAP blocks in patients having undergone emergency caesarean section has been undertaken.</p><p><strong>Aims: </strong>To investigate surgical TAP block and multimodal analgesic use during emergency caesarean section, the effect on surgical time, post-operative analgesia use, and admission length.</p><p><strong>Materials and methods: </strong>We performed a retrospective review of 250 patients who underwent emergency caesarean in 2022. Surgical TAP blocks were performed with 20 mL of 0.375% ropivacaine either side. Primary outcomes included surgical time, length of admission, time to first request of rescue opiate, opiate use in first post-operative 24 h, total dose used during admission, and opiates prescribed on discharge.</p><p><strong>Results: </strong>Ninety-six patients received surgical TAP blocks, and 154 did not. There were no statistically significant differences in the primary outcomes. Subgroup analyses were performed in patients who did not receive intrathecal morphine, body mass index over 30 kg/m<sup>2</sup>, for patients whom this was their first caesarean, and for TAP blocks versus local infiltration to the wound. There were no significant differences in the primary outcomes in these subgroups.</p><p><strong>Conclusions: </strong>Surgical TAP blocks did not prolong surgical time or decrease post-operative analgesia use or admission length in patients having undergone emergency caesarean. 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引用次数: 0
摘要
背景:有效且副作用小的镇痛药对产后患者和新生儿的健康至关重要。剖腹产后超声引导腹横肌平面(TAP)阻滞的安全性和有效性已得到证实。手术 TAP 阻滞似乎很有效,而且只需要很少的时间和设备。目的:研究紧急剖腹产手术中手术 TAP 阻滞和多模式镇痛的使用,以及对手术时间、术后镇痛使用和入院时间的影响:我们对 2022 年接受紧急剖腹产手术的 250 名患者进行了回顾性分析。两侧均使用 20 mL 0.375% 罗哌卡因进行手术 TAP 阻滞。主要结果包括手术时间、入院时间、首次要求使用阿片类药物抢救的时间、术后24小时内阿片类药物的使用情况、入院时使用的总剂量以及出院时开具的阿片类药物处方:结果:96名患者接受了手术TAP阻滞,154名患者未接受手术TAP阻滞。主要结果无统计学差异。对未接受鞘内吗啡治疗的患者、体重指数超过30 kg/m2的患者、首次剖腹产的患者以及TAP阻滞与伤口局部浸润的患者进行了分组分析。这些分组的主要结果没有明显差异:手术TAP阻滞不会延长紧急剖腹产患者的手术时间,也不会减少术后镇痛剂的使用或住院时间。尽管还需要更多的研究,但我们鼓励为患者量身定制多模式镇痛。
Retrospective review of surgeon administered transversus abdominis plane blocks at emergency caesarean.
Background: Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post-caesarean section ultrasound-guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment. No previous examination of surgical TAP blocks in patients having undergone emergency caesarean section has been undertaken.
Aims: To investigate surgical TAP block and multimodal analgesic use during emergency caesarean section, the effect on surgical time, post-operative analgesia use, and admission length.
Materials and methods: We performed a retrospective review of 250 patients who underwent emergency caesarean in 2022. Surgical TAP blocks were performed with 20 mL of 0.375% ropivacaine either side. Primary outcomes included surgical time, length of admission, time to first request of rescue opiate, opiate use in first post-operative 24 h, total dose used during admission, and opiates prescribed on discharge.
Results: Ninety-six patients received surgical TAP blocks, and 154 did not. There were no statistically significant differences in the primary outcomes. Subgroup analyses were performed in patients who did not receive intrathecal morphine, body mass index over 30 kg/m2, for patients whom this was their first caesarean, and for TAP blocks versus local infiltration to the wound. There were no significant differences in the primary outcomes in these subgroups.
Conclusions: Surgical TAP blocks did not prolong surgical time or decrease post-operative analgesia use or admission length in patients having undergone emergency caesarean. Patient-tailored multimodal analgesia is encouraged, although more research is needed.
期刊介绍:
The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.