Choi Sae Woong, Cho Shin Jay, Moon Hyong Woo, Lee Kyu Won, Lee Sang Hoon, Hong Sang Hyun, Choi Yong Sun, Bae Woong Jin, Ha U-Syn, Hong Sung-Hoo, Lee Ji Youl, Kim Sae Woong, Cho Hyuk Jin
Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Anesthesiology, St. Mary's Will Hospital, Seoul, Republic of Korea.
Urology. 2018 Apr;114:49-55. doi: 10.1016/j.urology.2017.12.004. Epub 2017 Dec 27.
To determine the efficacy of intercostal nerve block and nephrostomy tract infiltration (NTI) with ropivacaine in patients undergoing tubeless percutaneous nephrolithotomy (TPCNL).
From February 2015 to March 2017, a total of 226 patients undergoing TPCNL were enrolled. After excluding 130 patients who failed to meet the inclusion criteria, a total of 96 eligible patients were randomized into 3 groups: group I, control group (n = 32); group II, intercostal nerve block with 15 mL of 0.5% ropivacaine and epinephrine (n = 32); and group III, NTI with 20 mL of 0.25% ropivacaine and epinephrine (n = 32). Pain status was assessed at postoperative 2, 8, and 24 hours and at discharge by visual analog scale score at rest (RVAS) and on deep breathing and coughing.
Patient demographics and perioperative data between groups were comparable except for length of stay. Mean RVAS scores at postoperative 2 and 8 hours for group III were significantly less than those for group I (RVAS at 2 hours: 2.6 vs 4.9, P = .001; RVAS at 8 hours: 1.7 vs 3.3, P = .007). Mean RVAS scores at postoperative 24 hours had borderline significance (P = .050) among the 3 groups. Differences in mean deep breathing and coughing scores among groups were statistically significant (P = .002) only in the first 2 hours. All postoperative complications (5.4%, 5 per 92) were of grade 1 and not significantly different among groups.
NTI is safe and effective in alleviating early postoperative pain for patients who underwent TPCNL.
确定罗哌卡因肋间神经阻滞和肾造瘘通道浸润（NTI）在无管经皮肾镜取石术（TPCNL）患者中的疗效。
2015年2月至2017年3月，共纳入226例行TPCNL的患者。排除130例不符合纳入标准的患者后，共96例符合条件的患者被随机分为3组：I组，对照组（n = 32）；II组，用15 mL 0.5%罗哌卡因和肾上腺素进行肋间神经阻滞（n = 32）；III组，用20 mL 0.25%罗哌卡因和肾上腺素进行NTI（n = 32）。在术后2、8和24小时以及出院时，通过静息视觉模拟量表评分（RVAS）以及深呼吸和咳嗽时的评分来评估疼痛状况。
除住院时间外，各组间患者人口统计学和围手术期数据具有可比性。III组术后2小时和8小时的平均RVAS评分显著低于I组（2小时RVAS：2.6对4.9，P = 0.001；8小时RVAS：1.7对3.3，P = 0.007）。术后24小时的平均RVAS评分在3组间具有临界显著性（P = 0.050）。各组间平均深呼吸和咳嗽评分的差异仅在最初2小时具有统计学意义（P = 0.002）。所有术后并发症（5.4%，92例中有5例）均为1级，且各组间无显著差异。
NTI在减轻接受TPCNL患者的术后早期疼痛方面安全有效。
