Đánh giá giảm đau đa mô thức trong việc áp dụng ERAS cho phẫu thuật lấy thai cấp tại bệnh viện Trung ương Huế
Authors: Lê Văn Dũng 
Published: May 2023

Mục tiêu: Đánh giá hiệu quả giảm đau đa mô thức của morphine dưới nhện và gây tê TAP trong việc áp dụng ERAS cho phẫu thuật lấy thai cấp và khảo sát tỉ lệ các tác dụng phụ, biến chứng của nghiên cứu này.

Đối tượng, phương pháp: Nghiêm cứu tiến cứu mô tả cắt ngang. Tổng cộng, 515 sản phụ được chia thành hai nhóm, giảm đau sau mổ bằng morphine tủy sống (MTS): 295 và nhóm phong bế mặt phẳng ngang bụng (TAP): 220.

Kết quả: VAS trung bình của nhóm TMS (2,35 ± 0,26) thấp hơn nhóm TAP (3,54 ± 0,57). Nhóm MTS (1,36%) cần morphine giải cứu ít hơn nhóm TAP (15,91%) với p < 0,01. Tỉ lệ rút sonde tiểu sau mổ 12 giờ của nhóm MTS (60,48%) thấp hơn nhóm TAP (74,05%), p < 0,05. Vận động sớm sau mổ 2 giờ, ăn sớm sau mổ 6 giờ và thời gian chuyển sản phụ ra khỏi phòng hồi sức ở hai nhóm là tương đương nhau (p > 0,05). Mức độ hài lòng của sản phụ ở hai nhóm MTS và TAP (88,47%% và 85,90%) cũng tương đương nhau, p > 0,05. Tác dụng phụ: phát ban, ngứa cao hơn ở nhóm MTS (5,08%) so với nhóm TAP (2,72%), p < 0,05 và tỉ lệ nôn của nhóm MTS (10,51%) cao hơn nhóm TAP (3,18%), p < 0,01. Nhưng rét run ít hơn ở nhóm MTS (4,75%) so với nhóm TAP (8,63%) với p < 0,05. Apgar ở phút đầu tiên ở nhóm MTS (8,58 ± 0,25) và nhóm TAP (8,46 ± 0,27) khác biệt không có ý nghĩa thống kê.

Kết luận: Morphine trục thần kinh được coi là tiêu chuẩn vàng để giảm đau sau mổ lấy thai. Tê mặt phẳng cơ ngang bụng (TAP - Block) cải thiện giảm đau sau phẫu thuật lấy thai ở những bệnh nhân không nhận được morphine khoang dưới nhện, đây cũng là một sự lựa chọn đang được quan tâm.

ABSTRACT EVALUATION OF MULTIMODAL ANALGESIA IN THE APPLICATION OF ERAS FOR EMERGENCY CESAREAN SECTION AT HUE CENTRAL HOSPITAL

Objectives: To evaluate the multimodal analgesia of intrathecal morphine and TAP block in the application of ERAS for emergency cesarean section and to investigate the rate of side effects and complications of this study.

Methods: A prospective, cross-sectional descriptive study. Totally, 515 parturients were divided into two groups. Postoperative analgesia with spinal morphine (MTS): 295 and transverse abdominis plane (TAP) block group: 220.

Results: Average pain score (VAS) of the TMS group (2.35 ± 0.26) were lower than that of the TAP group (3.54 ± 0.57). The MTS group (1.36%) needed rescue morphine less than the TAP group (15.91%) with p < 0.01. The rate of urinary catheter removal within 12 hours of surgery of the MTS group (60.48%) was lower than that of the TAP group (74.05%), p < 0.05. Early exercise 2 hours, early eating 6 hours after surgery and the time to move parturients out of the recovery room in the two groups were similar (p > 0,05). Maternal satisfaction in the two groups MTS and TAP (88.47%% and 85.90%) were also similar, p > 0.05. Side effects: rash, itching was higher in MTS groups (5.08%) compared to TAP group (2.72%), p < 0.05, and the vomiting rate of the MTS group (10.51%) was higher than the TAP group (3.18%), p < 0.01. But chills were less in MTS group compared to TAP group with p < 0.05. Apgar at the first minute in the MTS group (8.58 ± 0.25) and the TAP group (8.46 ± 0.27) were not statistically significant.

Conclusion: Neuraxial morphine is considered the gold standard for post-cesarean analgesia. Transabdominal plane blocks (TAP - Blocks) improve postoperative analgesia after cesarean delivery in patients who did not receive intrathecal morphine, which is also an option of interest.