添加Epinephrine對髂腹股溝神經阻斷術於剖腹產後的傷口止痛作用的評估

ILIOINGUINAL NERVE BLOCKADE WITH OR WITHOUT EPINEPHRINE FOR ANALGESIA AFTER CAESAREAN SECTION

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

《Acta Anaesthesiologica Sinica》 28卷3期 (1990/09) Pp. 351-355

摘要

本研究足以較低濃度的0.375%Marcaine作兩側髂腹股溝神經阻斷術，從而評估其於剖腹產後的傷口止痛效果；此外我們也探討添加Epinephrine對此神經阻斷術的影響。36位ASA分類第一級或第二級的產婦被隨機分成3組，每組12人。所有產婦皆在相同用藥的全身麻醉下接受經Pfannenstiel線切開的低位帝王剖腹術。術後，A組12人作為控制組，B組12人以0.375%Marcaine各10mL作兩側髂腹股溝神經阻斷術；而C組12人則給予合1:200000 epinephrine的0.375% marcaine各10mL作同樣阻斷術。結果顯示，有施行神經阻斷術的產婦（B組及C組）在術後的前8個小時的疼痛分數比控制組的平均降低了30%及37%。其中C組的產婦在24小時內的疼痛分數都比控制組的有統計上差異。在Pethidine總注射次數及平均注射量方面，三組均沒有統計上差異。但在首次注射Pethidine時間方面B組及C組的4.57小時及4.38小時比A組的1.8小時延長。因此我們認為兩側髂腹股溝神經阻斷術是可以減輕剖腹產產婦手術後的傷口痛，從而延後了注射Pethidine的時間；而Epinephrine的添加亦可，延長神經阻斷的時間。

關鍵字

髂腹股溝神經阻斷術 ； Epinephrine ； Pfannenstiel incision ； 剖腹產 ； 術後傷口止痛

並列摘要

The analge sic effect of bilateral ilioinguinal nerve blockade with or without epinephrine after caesarean section with Pfannenstiel incision was investigated in 36 ASA class 1-2 parturients. They were randomly classified into 3 groups o f 12 each. Before the patients were extubated from standard general anesthesia, bilateral ilioinguinal nerve blockade was performed. Group A patients were the control group. Group 8 patients received 0.375% plain marcaine 10 mL to each side. Group C patients received 0.375% plain marcaine with 1:200000 epinephrine 10 mL to each side. The pain scores and requirement for post operative analgesia of group B and C were compared with the control group A. The pain scores of group Band C were decreased 30% and 37% respectively during the first eight hours after operation. Horeover, group C patients had lower pain scores during the first day after operation. There was an increased time from anesthesia to the first injection of pethidine in group 8 and C when compared with group A (4.57±2 .94 , 4.38±2.72 and 1.8±0.9 hr, respectiveiy). However, no significant difference between group B and C. The total pethidine requirement were decreased in group Band C although the mean pethidine dose was not statistically significant. The results suggest that bilateral ilioinguinal nerve blockade improve the quality of postoperative analgesia. The adding epinephrine can prolong the duration of nerve blockade.