Nghiên cứu hiệu quả của gây tê khoang cơ vuông thắt lưng phối hợp dexamethason tĩnh mạch so với morphin khoang dưới nhện sau phẫu thuật lấy thai

Post-cesarean section pain management is a critical aspect of obstetric care, profoundly impacting maternal recovery and overall well-being. Adequate postoperative analgesia facilitates early ambulation, breastfeeding, and reduces the risk of chronic pain. While intrathecal morphine has long been considered a gold standard for its effective and prolonged pain relief, its associated side effects, such as nausea, vomiting, pruritus, and respiratory depression, necessitate exploration of alternative strategies. Regional anesthetic techniques, particularly the quadratus lumborum block, combined with adjuvant medications like intravenous dexamethasone, show promise in mitigating these adverse effects. However, a direct comparative assessment of their analgesic efficacy and safety profile against intrathecal morphine in the context of post-cesarean analgesia remains an area requiring further investigation to guide optimal clinical practice.

Anesthesiologists, obstetricians, pain management specialists, researchers in regional anesthesia, and medical residents.

This randomized comparative study aimed to evaluate the effectiveness of quadratus lumborum block (QBL) combined with intravenous Dexamethasone versus intrathecal Morphine for postoperative pain control following cesarean section. Conducted on 130 parturients, the methodology involved comparing pain scores (VAS) at rest and during movement, alongside the incidence of side effects, over a 24-hour period. Results indicated that while the intrathecal Morphine group demonstrated significantly lower VAS scores from 4 to 24 hours, suggesting superior pain relief, the QBL combined with intravenous Dexamethasone group exhibited a significantly lower incidence of side effects (9.2% vs. 43.1%). The duration of postoperative pain relief was consequently lower, and the need for rescue analgesia was higher in the QBL group. These findings suggest that although intrathecal Morphine provides more sustained and potent analgesia, the QBL with intravenous Dexamethasone offers a compelling alternative due to its remarkably reduced side effect profile. This implies a trade-off between analgesic potency and safety, guiding clinicians to tailor pain management strategies based on individual patient needs and tolerance for side effects, highlighting the potential for QBL as a safer option for patients sensitive to opioid side effects. Future research could focus on optimizing QBL techniques or combining it with other analgesics to enhance its efficacy.