Academic Unit of Obstetrics & Gynaecology, St Mary's Hospital, Hathersage Road, Manchester M13 9WL, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2012 Feb;160(2):196-200. doi: 10.1016/j.ejogrb.2011.10.015. Epub 2011 Nov 21.
To describe the surgical rectus sheath block for post-operative pain relief following major gynaecological surgery.
Local anaesthetic (20 ml 0.25% bupivacaine bilaterally) is administered under direct vision to the rectus sheath space at the time of closure of the anterior abdominal wall.
We conducted a retrospective case note review of 98 consecutive patients undergoing major gynaecological surgery for benign or malignant disease who received either standard subcutaneous infiltration of the wound with local anaesthetic (LA, n=51) or the surgical rectus sheath block (n=47) for post-operative pain relief.
(1) Pain scores on waking, (2) duration of morphine-based patient controlled analgesia (PCA), (3) quantity of morphine used during the first 48 post-operative hours and (4) length of post-operative stay.
The groups were similar in age, the range of procedures performed and the type of pathology observed. Patients who received the surgical rectus sheath block had lower pain scores on waking [0 (0-1) vs. 2 (1-3), p<0.001], required less morphine post-operatively [12 mg (9-26) vs. 36 mg (30-48), p<0.001], had their PCAs discontinued earlier [24h (18-34) vs. 37 h (28-48), p<0.001] and went home earlier [4 days (3-4) vs. 5 days post-op (4-8), p<0.001] [median (interquartile range)] than patients receiving standard subcutaneous local anaesthetic into the wound.
The surgical rectus sheath block appears to provide effective post-operative analgesia for patients undergoing major gynaecological surgery. A randomised controlled clinical trial is required to assess its efficacy further.
描述用于妇科大手术后缓解术后疼痛的外科腹直肌鞘阻滞技术。
在关闭前腹壁时，直视下将局部麻醉剂（双侧 20ml0.25%布比卡因）注入腹直肌鞘间隙。
我们对 98 例连续接受妇科大手术治疗良性或恶性疾病的患者进行了回顾性病历回顾，这些患者分为两组：一组接受标准的皮下局部麻醉剂浸润（n=51），另一组接受外科腹直肌鞘阻滞（n=47）以缓解术后疼痛。
（1）苏醒时的疼痛评分；（2）吗啡类患者自控镇痛（PCA）的持续时间；（3）术后 48 小时内使用的吗啡量；（4）术后住院时间。
两组患者在年龄、手术范围和观察到的病理类型方面相似。接受外科腹直肌鞘阻滞的患者苏醒时疼痛评分较低[0（0-1）vs.2（1-3），p<0.001]，术后需要的吗啡量较少[12mg（9-26）vs.36mg（30-48），p<0.001]，PCA 停止更早[24h（18-34）vs.37h（28-48），p<0.001]，更早出院[4 天（3-4）vs.术后 5 天（4-8），p<0.001][中位数（四分位间距）]。
外科腹直肌鞘阻滞似乎为妇科大手术患者提供了有效的术后镇痛。需要进行随机对照临床试验以进一步评估其疗效。
