Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
World J Surg. 2012 Dec;36(12):2831-7. doi: 10.1007/s00268-012-1780-0.
Nerve blocks and infiltration with local anesthetics are commonly employed methods for postoperative pain control. This prospective, randomized trial was conducted to determine whether bilateral superficial cervical plexus block (BSCPB) is effective for reducing acute postoperative pain after robot-assisted endoscopic thyroidectomy (RAET) and to compare its effects with that of local wound infiltration (LWI).
Ninety-seven patients who were to undergo RAET were randomly assigned to one of three groups to receive BSCPB with either 20 mL of 0.525% ropivacaine (BSCPB group, n=32) or 20 mL of isotonic sodium chloride solution (Control group, n=32) or LWI with 20 mL of 0.525% ropivacaine (LWI group, n=33). Postoperative pain scores were assessed at the postoperative anesthesia care unit (PACU) and at 6, 24, and 48 h postoperatively using a visual analog scale (VAS). Patients with VAS scores of ≥40 were administered rescue analgesics according to a standardized protocol. The main outcome variables were pain scores during the first postoperative 24 h and the number of patients requiring postoperative analgesic rescue.
The BSCBP and LWI groups showed lower pain scores compared with the Control group at the PACU. The BSCPB group continued to show significantly lower pain scores compared with the LWI and Control groups at postoperative 6 and 24 h. The number of patients requiring analgesic rescue at the PACU was lower in the BSCPB and LWI groups than in the Control group. The number of patients requiring additional rescue analgesics after discharge from the PACU until the first 24 postoperative h was lower in the BSCPB group than in the LWI group.
BSCPB and LWI are effective for reducing pain scores and analgesic requirements during the immediate postoperative period in patients who undergo RAET, with BSCPB being superior to LWI at postoperative 6-24 h.
神经阻滞和局部麻醉浸润是术后疼痛控制的常用方法。本前瞻性、随机试验旨在确定双侧颈浅丛阻滞（BSCPB）是否可有效减轻机器人辅助内镜甲状腺切除术（RAET）后的急性术后疼痛，并比较其与局部伤口浸润（LWI）的效果。
97 例行 RAET 的患者被随机分配至三组，分别接受 20 mL 0.525%罗哌卡因的 BSCPB（BSCPB 组，n=32）、20 mL 等渗生理盐水（对照组，n=32）或 20 mL 0.525%罗哌卡因的 LWI（LWI 组，n=33）。术后在麻醉后护理单元（PACU）以及术后 6、24 和 48 h 采用视觉模拟评分法（VAS）评估术后疼痛评分。VAS 评分≥40 的患者根据标准化方案给予解救性镇痛。主要观察指标为术后 24 h 内的疼痛评分和需要术后镇痛解救的患者人数。
BSCPB 和 LWI 组在 PACU 时的疼痛评分低于对照组。BSCPB 组在术后 6 和 24 h 时的疼痛评分仍明显低于 LWI 组和对照组。BSCPB 组和 LWI 组在 PACU 时需要镇痛解救的患者人数少于对照组。从 PACU 出院至术后 24 h 内，BSCPB 组需要额外解救性镇痛的患者人数少于 LWI 组。
BSCPB 和 LWI 可有效降低 RAET 患者术后即刻疼痛评分和镇痛需求，BSCPB 在术后 6-24 h 优于 LWI。
