Effect of ultrasound-guided anesthesia with different block anesthesia on postpartum analgesia and cellular immunity for HIV-infected pregnant women after cesarean section

Abstract:

Objective: To study the analgesic effect of transversus abdominis plane block（TAPB） and quadratus lumborum block（QLB） on postpartum caesarean section of human immunodeficiency virus（HIV）-infected pregnant women and its influence on cellular immunity. Methods: Sixty HIV-infected pregnant women who underwent cesarean section in Chongqing Public Health Medical Center，aged 22-32，body mass index（BMI） 18-25 kg/m²，ASA Ⅱ. They were randomly divided into TAPB group and QLB group，with 30 cases in each group. Both groups were treated with combined spinal-epidural anesthesia，and underwent patient controlled intravenous analgesia（PCIA） after operation. The QLB group underwent ultrasound-guided bilateral QLB，and ultrasound-guided TAPB was conducted in TAPB group. The scores of resting VAS were recorded at 4 h，8 h，12 h，24 h，36 h after operation. The levels of interleukin（IL）-2，IL-13，interferon-γ（IFN-γ），CD3⁺，CD4⁺，CD8⁺ and CD4⁺/ CD8⁺ in peripheral blood were observed by 1 day before the operation and 1 day，2 days and 3 days after the operation. And the first compression time of the analgesic pump，the number of postoperative salvage analgesia cases，the success rate of one puncture and adverse anesthesia reactions. Results: Compared with the TAPB group at 4 h，8 h，12 h，24 h，and 36 h after surgery，the static VAS pain scores in the QLB group were significantly lower at each time point（P<0.05）. Compared with the TAPB group 1 day，2 days and 3 days after the operation，the IL-2，IL-13，IFN-γ concentration，CD4⁺ and CD4⁺/CD8⁺ in the QLB group were significantly increased at each time point（P<0.05）. The first compression time of the analgesic pump in the QLB group was significantly later than that in the TAPB group（P<0.05），and the rate of remedial analgesia was significantly lower than that in the TAPB group（P<0.05）. Conclusion: Post-operative cesarean section for HIV-infected pregnant women has better analgesia effect with QLB and can reduce the impact on the cellular immunity.