Nghiên cứu hiệu quả của gây tê mặt phẳng cơ ngang bụng trong giảm đau đa mô thức sau phẫu thuật lấy thai
Authors: Trà Phú 
Published: May 2023

Mục tiêu: Nghiên cứu hiệu quả và tính an toàn của gây tê mặt phẳng cơ ngang bụng (TAP block) dưới hướng dẫn siêu âm trong giảm đau đa mô thức sau phẫu thuật lấy thai tại Bệnh viện Trung ương Huế cơ sở 2.

Đối tượng, phương pháp: 80 sản phụ ASA1, ASA2, có chỉ định phẫu thuật lấy thai, đường mổ Pfannenstiel, chia ngẫu nhiên vào hai nhóm: nhóm TAPB gồm 40 sản phụ được gây tê TAP block bằng levobupivacaine 0.25% 18ml mỗi bên, nhóm chứng gồm 40 sản phụ không gây tê TAP block. Cả hai nhóm đều sử dụng paracetamol 1g truyền tĩnh mạch mỗi 6 giờ và voltaren 100mg (diclofenac) nhét hậu môn. Sử dụng 5mg morphine bolus tĩnh mạch khi điểm đau lớn hơn hoặc bằng 4. Đánh giá hiệu quả giảm đau khi nghỉ ngơi, lúc vận động bằng thang điểm nhìn hình đồng dạng VAS tại các thời điểm 2, 4, 6, 8, 10, 12 giờ sau phẫu thuật, tổng liều morphine sử dụng ở cả 2 nhóm, tác dụng phụ nếu có.

Kết quả: Tại thời điểm 2 giờ sau phẫu thuật, điểm đau của hai nhóm tương đương, tuy nhiên từ giờ thứ 4 trở đi, nhóm TAPB có điểm VAS khi nghỉ ngơi và vận động thấp hơn có ý nghĩa thống kê so với nhóm chứng (p < 0.05), tổng liều morphine sử dụng ở nhóm chứng nhiều hơn nhóm TAPB (p < 0.05). Thời gian giảm đau trung bình của nhóm TAPB là 9.8 ± 0.5 giờ. Tác dụng phụ: buồn nôn, nôn, ngứa ở nhóm chứng cao hơn (p < 0.05). Chưa ghi nhận biến chứng gây tê ở nhóm TAPB.

Kết luận: Gây tê mặt phẳng cơ ngang bụng TAP block tỏ ra hiệu quả khi làm giảm điểm đau lúc nghỉ và vận động, giảm tổng liều morphine cần sử dụng và an toàn trong quá trình thực hiện. Vì vậy, TAP block là kĩ thuật có hiệu quả trong chiến lược giảm đau đa mô thức sau phẫu thuật lấy thai.

Từ khóa: TAP block, giảm đau đa mô thức.

ABSTRACT EFFICACY AND SAFETY OF TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE C - SECTION ANALGESIA

Objectives: We do this study with the aim: to study the efficacy and safety of TAP block under ultrasound guidance in multimodal analgesia after cesarean section at Hue Central Hospital 2.

Methods: 80 ASA 1 and ASA 2 parturients for C-section via Pfannestiel incision under spinal anesthesia were divided into 2 groups: TAPB group used TAP block and the controlled group. In TAPB group, we injected 18ml Levobupivacaine 0.25% per side by using ultrasound. We don’t do TAP block in controlled group. Both groups also used intravenous paracetamol 1g every 6 hours and rectal diclofenac 100mg. Visual analog scale (VAS) pain score, total morphine consumed, side effects of 2 groups were scored at 2, 4, 6, 8, 10, 12h postoperatively.

Results: At 2 hours after surgery, pain scores of the two groups were similar, however from the 4th hour onwards, the TAPB group had statistically significant lower VAS scores at rest and movement compared to the control group (p) < 0.05), the total dose of morphine used in the control group was higher than in the TAPB group (p < 0.05). The average pain relief time of the TAPB group was 9.8 ± 0.5 hours. Side effects: nausea, vomiting, itching were higher in the control group (p < 0.05). No complications were observed in the TAPB group.

Conclusions: TAP block is effective when it comes to reducing pain score at rest and movement, reducing the total dose of morphine required and is a safe local anesthesia procedure. Therefore, TAP block is an effective technique in a multimodal analgesia strategy after a cesarean section.