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

Abstract

Background: 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.