ILIOINGUINAL NERVE BLOCK WITH 0.375% MARCAINE FOR POSTOPERATIVE PAIN RELIEF IN CESEREAN SECTION

0.375%Marcaine腸骨腹股溝神經阻斷術對剖腹產術後疼痛的治療

謝永成(Yong-Seng Seah) ； 陳捷(Chit Chen) ； 伍乙棠(Yuet-Tong Ng) ； 蔡榮財(Eng-Chye Chua) ； 譚培炯(Peter P.C. Tan)

《Acta Anaesthesiologica Sinica》 28卷3期 (1990/09) Pp. 307-310

摘要

Bilateral ilioinguinal nerve block wit h local anesthetic drugs to treat postoperative pain in lower segment cese-rean section (Pfannestiel incision) under general anesthesia had show profound effective by P. Bunting and I. McConachie. We used the same method but with lower concentration 0.375% marcaine 10ml to each side in 12 patients. We compare the pain score and the requirement for pethidine intramuscular injection to 12 patients as control group. Pain score were less in the block patients within 8h after surgery, and total amount of pethidine given was 700 mg. In control group, the pain score were higher at the first 8 h than nerve block group during the study (p ＜0.05), and the total amount of pethidine requirement was 1250mg. There were no observed adverse effect during the study.

關鍵字

Ilioinguinal nerve block ； Marcaine ； Postoperative Pain relief in Ceserean section

並列摘要

神經阻斷術作為術後止痛治療已漸廣被接受和使用。其好處是不需特別設備及特別受訓護士的照顧，同時也不影響呼吸系統。P. bunting和I.McConachie曾應用兩側腸骨腹股溝神經阻斷術於施行Pfannensfiel切開法低位帝王剖腹術之產婦。以作為術後傷口止痛，並且得到良好效果。本實驗是以24位要求全身麻醉並採用Pfannensfiel切開法低位帝王剖腹術之產婦作為實驗對象。第一組12人是在手術結束時，由麻醉科醫師在病人未清醒前，施行兩側腸骨腹股溝神經阻斷術，每側各施打0.375% Marcaine 10ml，另一組12人則為對照組，未施打任何局部麻醉劑。本實驗目的是希望藉著兩組病人對術後傷口疼痛的評分及要求Pethidine肌肉注射總劑量的比較，來評估使用0.375% Marcaine行歸骨腹股溝神經阻斷術的街後止痛效果。我們是依類比式疼痛計分表，來評估疼痛的情況，分別於術後一小時，四小時、八小時、十二小時及二十四小時評估一次。實驗結果發現施行腸骨腹股溝神經阻斷術組，具有明顯止痛效果。其疼痛分數在街後8小時內比對照組有明顯的降低，同時對pethidine肌肉注射總量比對照組有顯著的減少。但是對於臟器與腹膜的術後疼痛，未有很好止痛效果，因此我們建議：對於要求全身麻醉進行Pfannensfiel切開法低位帝王剖腹術的產婦兩側腸骨腹股溝神經阻斷不失為一安全，有效的術後止痛治療方法之一。