Segal Dror, Awad Nibal, Nasir Hawash, Mustafa Susana, Lowenstein Lior
Department of Anesthesiology, Technion-Israel Institute of Technology, Haifa, Israel.
Int Urogynecol J. 2014 Mar;25(3):369-74. doi: 10.1007/s00192-013-2194-8. Epub 2013 Aug 9.
Gynecologic laparoscopic surgery is frequently accompanied by early postoperative pain. This study assessed the effect of combined general and spinal anesthesia on postoperative pain score, analgesic use, and patient satisfaction following robotic surgeries.
This was a randomized controlled trial. Thirty-eight consecutive women who underwent robotic surgeries for pelvic organ prolapse (sacrocolpopexy with or without subtotal hysterectomy) were randomly assigned to receive general anesthesia (control group, n = 20) or combined general with spinal anesthesia (study group, n = 18). Pain scores were assessed at rest and while coughing using a visual analog scale (VAS) 0-10. Dosage of analgesic medication consumption was retrieved from patients' charts.
There were no statistically significant differences between the two groups with respect to demographic data and intraoperative hemodynamic parameters. In the postanesthesia care unit (PACU) mean total IV morphine and meperidine dosages were significantly lower for the study than the control group (0.33 vs 7.59 mg, 1.39 vs 27.89 mg, respectively, P < 0.003, <0.001, respectively). In addition, a significantly lower percentage of patients belonging to the study group demanded analgesic medications while in the PACU (33 vs 53 %, P = 0.042). Pain scores in the PACU and during postoperative day 1 were significantly lower in the study group than in the control group (delta VAS 1.9 vs 3.0, P = 0.04). Satisfaction with pain treatment among both patients and nurses was significantly higher in the study group.
Reported levels of pain and analgesic use during the first 24 h following robotic gynecologic surgery were significantly lower following general and spinal anesthesia compared to general anesthesia alone.
妇科腹腔镜手术术后常伴有早期疼痛。本研究评估了全身麻醉联合脊髓麻醉对机器人手术后疼痛评分、镇痛药物使用及患者满意度的影响。
这是一项随机对照试验。38例连续接受机器人手术治疗盆腔器官脱垂（骶骨阴道固定术，伴或不伴子宫次全切除术）的女性被随机分为接受全身麻醉（对照组，n = 20）或全身麻醉联合脊髓麻醉（研究组，n = 18）。使用0 - 10视觉模拟量表（VAS）评估静息和咳嗽时的疼痛评分。从患者病历中获取镇痛药物的用量。
两组在人口统计学数据和术中血流动力学参数方面无统计学显著差异。在麻醉后护理单元（PACU），研究组的静脉注射吗啡和哌替啶的平均总剂量显著低于对照组（分别为0.33 vs 7.59 mg，1.39 vs 27.89 mg，P分别<0.003，<0. : 001）。此外，研究组在PACU期间需要镇痛药物的患者比例显著更低（33% vs 53%，P = 0.042）。研究组在PACU和术后第1天的疼痛评分显著低于对照组（VAS差值1.9 vs 3.0，P = 0.04）。研究组患者和护士对疼痛治疗的满意度显著更高。
与单纯全身麻醉相比，机器人妇科手术后24小时内，全身麻醉联合脊髓麻醉后的疼痛和镇痛药物使用水平显著更低。
