目的 比较布比卡因脂质体与罗哌卡因用于剖宫产术后腹横肌平面阻滞（TAP）联合静脉镇痛的临床疗效，探讨布比卡因脂质体的镇痛优势。 方法 纳入我院行择期剖宫产术的产妇80例，采用随机数表法分为布比卡因脂质体组和罗哌卡因组，两组患者均于术毕，在超声引导下行双侧TAP阻滞，罗哌卡因组患者每侧注射0.5%罗哌卡因20 mL。布比卡因脂质体组取266 mg布比卡因脂质体溶于0. 9%生理盐水至40 mL，每侧注入20 mL，比较两组患者术后各时点静息及运动时VAS 评分、术后15项恢复质量（QoR15）的总体评分、术后阿片类药物的消耗量、术后首次下地行走时间和排气时间，恶心、呕吐、便秘、瘙痒的发生率及药物的不良反应等。 结果 布比卡因脂质体组术后12、24、48 h时点的静息痛及运动痛VAS评分显著低于罗哌卡因组（P < 0.001）。布比卡因脂质体组术后24 h及24 ~ 48 h的QoR-15评分为显著高于罗哌卡因组（P < 0.001）。术后48 h内阿片类药物消耗量布比卡因脂质体组显著低于罗哌卡因组（P < 0.001）。布比卡因脂质体组首次排气时间显著短于罗哌卡因组（P < 0.001）。两组患者恶心呕吐、便秘、发生率差异均无统计学意义（P > 0.05），均未发生瘙痒或其他严重不良反应。 结论 布比卡因脂质体用于剖宫产术后TAP阻滞可提供长效镇痛，减少阿片类药物需求，改善术后恢复质量，有助于促进胃肠蠕动且安全性良好。

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.