Objective To compare the analgesic effects and related complications of a single-dose epidural analgesia (EA), quadratus lumborum block (QLB), and iliohypogastric/ilioinguinal nerve block (IINB) for post-cesarean analgesia.
Methods Eighty-seven parturients from November 2020 to March 2021, undergoing first cesarean section under combined spinal-epidural anesthesia were selected, aged 23-42 years, BMI 21-37 kg/m2, ASA physical status Ⅱ, gestational period 37-42 weeks, were randomly divided into three groups using random number table method: group EA, group QLB and group IINB, 29 parturients in each group. At the end of operation, a single-dose epidural morphine combined with ropivacaine was administered in group EA, ultrasound-guided bilateral QLB and bilateral IINB were performed in group QLB and group IINB, respectively. All the parturients received morphine via patient-controlled intravenous analgesia (PCIA) pump for remedial analgesia. Morphine consumption and NRS scores at rest or during exercise 6, 12, 24, and 48 hours postoperation were recorded. The time when parturients use analgesia pump for the first time and the total times parturieuts used the pump within 48 hours were recorded. And related adverse reactions (nausea and vomiting, pruritus, excessive sedation, respiratory depression, urinary retention, and lower extremity venous thrombosis) were recorded.
Results Compared with group EA, morphine consumption 12 and 24 hours after operation, and the total times parturients used the pump within 48 hours were increased significantly in groups QLB and IINB (P < 0.05), the incidence of nausea and vomiting and pruritus were decreased significantly in groups QLB and IINB (P < 0.05). There were no significantly differences of morphine consumption 6 and 48 hours after operation, NRS scores at rest and during exercise 6, 12, 24, and 48 hours postoperatively and the time using analgesia pump for the first time in the three groups. There were no excessive sedation, respiratory depression, urinary retention, or lower extremity venous thrombosis happened in the three groups.
Conclusion The analgesic effect of a single-dose epidural analgesia after cesarean section is superior than that of QLB and IINB. However, the incidence of postoperative nausea-vomiting and pruritus is higher in epidural morphine. The analgesic effect of QLB and IINB is similar. |
