关键词: 布比卡因脂质体, 罗哌卡因, 剖宫产, 疼痛评分, 恢复质量

Abstract:

Objective To comparatively evaluate the clinical efficacy of liposomal bupivacaine and ropivacaine in transversus abdominis plane （TAP） block combined with intravenous patient?controlled analgesia （PCA） following cesarean section， and to explore the analgesic advantages of liposomal bupivacaine. Methods Eighty parturients scheduled for elective cesarean section were recruited and randomly allocated into two groups via a random number table： the liposomal bupivacaine group and the ropivacaine group. At the conclusion of the surgical procedure， both groups underwent ultrasound?guided bilateral TAP block. In the ropivacaine group， 20 mL of 0.5% ropivacaine was administered per side. In the liposomal bupivacaine group， 266 mg of liposomal bupivacaine was dissolved in 0.9% normal saline to a total volume of 40 mL， with 20 mL injected per side. The following parameters were compared between the two groups： Visual Analog Scale （VAS） scores at rest and during movement at various postoperative time points， the overall scores of the 15?item Quality of Recovery （QoR?15） scale， postoperative opioid consumption， the time to first ambulation， the time to first flatus， and the incidence of adverse drug reactions such as nausea， vomiting， constipation， and pruritus. Results In comparison with the ropivacaine group， the liposomal bupivacaine group exhibited significantly lower Visual Analogue Scale （VAS） scores both at rest and during movement at 12 hours， 24 hours， and 48 hours postoperatively （P < 0.001）. Significantly higher Quality of Recovery?15 （QoR?15） scores were recorded in the liposomal bupivacaine group at 24 hours and during the 24? 48? hour period postoperatively （P < 0.001）. The postoperative opioid consumption within 48 hours was markedly lower in the liposomal bupivacaine group （P < 0.001）. The time to first flatus was significantly shorter in the liposomal bupivacaine group （P < 0.001）. No significant differences were detected in the incidence of nausea， vomiting， or constipation between the two groups （P > 0.05）， and no cases of pruritus or other severe adverse reactions were observed. Conclusion Liposomal bupivacaine used for TAP block following cesarean section offers extended analgesia， reduces the need for opioids， enhances the quality of postoperative recovery， promotes gastrointestinal motility， and demonstrates excellent safety.

Key words: liposome bupivacaine, ropivacaine, cesarean section, pain score, recovery quality