Nghiên cứu hiệu quả giảm đau đa mô thức bằng gây tê mặt phẳng cơ ngang bụng dưới hướng dẫn siêu âm kết hợp các thuốc giảm đau đường toàn thân sau phẫu thuật lấy thai

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Tác giả: Văn Long Lê, Thị Thoại Nguyễn, Văn Minh Nguyễn, Thắng Phan, Thị Sáu Trần

Ngôn ngữ: vie

Ký hiệu phân loại: 617 Miscellaneous branches of medicine Surgery

Thông tin xuất bản: Tạp chí y học việt nam (tổng hội y học việt nam), 2022

Mô tả vật lý: 94-99

Bộ sưu tập: Metadata

ID: 489608

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Intrathecal morphine currently represents the "gold standard" for providing effective post-cesarean analgesia, however, it causes many adverse effects. Multimodal analgesia reduces adverse effects. The objective of this study was to evaluate the effectiveness of multimodal analgesia by ultrasound-guided transversus abdominis plane block (TAP block) in combination with systemic analgesics after cesarean delivery (CS). Materials and method(:) In a randomized controlled clinical trial, 180 parturients after CS were randomly divided into 3 groups, respectively Para-TAP, Diclo-TAP and Para-Diclo. Group Para-TAP received paracetamol and TAP block, group Diclo-TAP received diclofenac and TAP block, group Para-Diclo received paracetamol and diclofenac. Pain intensity was assessed by using the visual analogue scale (VAS) at 1, 2, 4, 6, 8, 12, 18, 24 h and the functional activity score (FAS) during 24 h postoperatively. Five milligrams of morphine IV were reserved for rescue when VAS score at rest ≥ 4 or on movement ≥ 5. Results(:) Regarding VAS score, parturients with pain score up to 3 in group Para-TAP accounted for a high rate at rest and a low rate on movement, whereas group Diclo-TAP and Para-Diclo accounted for a high rate both at rest and on movement
group Para-TAP was more effective than group Para-Diclo in the period of 4 to 6 h
group Para-Diclo was more effective than group Para-TAP from 12 to 24 h
group Diclo-TAP was more effective than group Para-Diclo from 2 to 8 h. FAS score of A level in group Para-TAP accounted for 90% in the period from 1 to 8 h, more than 50% from 8 to 16 h, more than 60% from 16 to 24 h and 23.33% parturients required IV morphine rescue. FAS score of A level in group Diclo-TAP accounted for 100% in the period from 1 to 8 h, nearly 80% from 8 to 24 h and 10% parturients required IV morphine rescue. FAS score of A level in group Para-Diclo accounted for nearly 70% in the period from 1 to 16 h, nearly 90% from 16 - 24 h and 10% parturients required IV morphine rescue. Adverse effects were low rate and mild level in 3 groups. Conclusion(:) Group Para-TAP provided effective analgesia in the first 8 h, group Diclo-TAP in the 24 h, and better group Para-Diclo from from 2 to 8 h after CS. Adverse effects were low rate and mild in 3 groups.Morphin khoang dưới nhện được xem là "tiêu chuẩn vàng" trong giảm đau sau phẫu thuật lấy thai (PTLT), tuy nhiên nó gây ra nhiều tác dụng không mong muốn. Phương pháp giảm đau đa mô thức giúp giảm đau hiệu quả đồng thời giảm các tác dụng không mong muốn. Mục tiêu của nghiên cứu này là đánh giá hiệu quả giảm đau đa mô thức bằng gây tê mặt phẳng cơ ngang bụng dưới hướng dẫn siêu âm kết hợp các thuốc giảm đau đường toàn thân sau PTLT. Đối tượng và phương pháp nghiên cứu(:) Trong một thử nghiệm lâm sàng ngẫu nhiên đối chứng, 180 sản phụ (SP) sau PTLT được chia ngẫu nhiên thành 3 nhóm lần lượt là Para-TAP, Diclo-TAP và Para-Diclo. Nhóm Para-TAP được dùng paracetamol kết hợp gây tê mặt phẳng cơ ngang bụng (gây tê TAP), nhóm Diclo-TAP được dùng diclofenac đường trực tràng kết hợp gây tê TAP, nhóm Para-Diclo được dùng paracetamol kết hợp diclofenac đường trực tràng. Cường độ đau được đánh giá theo thang điểm đau nhìn hình đồng dạng (VAS) tại các thời điểm 1, 2, 4, 6, 8, 12, 18, 24 giờ và theo thang điểm hoạt động chức năng (FAS) trong 24 giờ sau phẫu thuật, thống kê tỉ lệ yêu cầu giải cứu đau và các tác dụng không mong muốn của các phương pháp. Giải cứu đau bằng 5 mg morphin tiêm tĩnh mạch chậm khi điểm VAS nghỉ ≥ 4 hoặc VAS vận động ≥ 5. Kết quả(:) Về điểm đau VAS, các SP có điểm đau từ 3 trở xuống trong nhóm Para-TAP chiếm tỉ lệ cao lúc nghỉ, nhưng thấp khi vận( )động
trong khi đó nhóm Diclo-TAP và Para-Diclo chiếm tỉ lệ cao cả lúc nghỉ ngơi và vận động
nhóm Para-TAP hiệu quả hơn nhóm Para-Diclo từ 4 - 6 giờ đầu
nhóm Para-Diclo hiệu quả hơn nhóm Para-TAP từ 12 - 24 giờ
nhóm Diclo-TAP hiệu quả hơn nhóm Para-Diclo từ 2 - 8 giờ. Nhóm Para-TAP có điểm FAS đạt mức A chiếm 90% trong khoảng thời gian từ 1 - 8 giờ, hơn 50% từ 8 - 16 giờ, hơn 60% từ 16 - 24 giờ
có 23,33% SP cần giải cứu đau. Nhóm Diclo-TAP có điểm FAS đạt mức A chiếm 100% trong khoảng thời gian từ 1 - 8 giờ, gần 80% từ 8 - 24 giờ
có 10% SP cần giải cứu đau. Nhóm Para-Diclo có điểm FAS đạt mức A chiếm gần 70% trong khoảng thời gian từ 1 - 16 giờ, gần 90% từ 16 - 24 giờ, có 10% SP cần giải cứu đau. Tác dụng không mong muốn chiếm tỉ lệ thấp và mức độ nhẹ ở 3 nhóm. Kết luận(:) Nhóm Para-TAP có hiệu quả giảm đau tốt trong 8 giờ đầu, nhóm Diclo-TAP có hiệu quả giảm đau tốt trong 24 giờ và tốt hơn nhóm Para-Diclo trong 8 giờ đầu sau phẫu thuật, tác dụng không mong muốn của các nhóm chiếm tỉ lệ thấp và mức độ nhẹ ở 3 nhóm.

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