Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Int J Surg. 2019 Feb;62:47-53. doi: 10.1016/j.ijsu.2019.01.004. Epub 2019 Jan 14.
Ultrasound-guided nerve blocks are effective; however, their use in the abdominal wall is reportedly associated with a risk of abdominal organ injury. Laparoscopic-guided nerve blocks are thought to be safer than ultrasound-guided nerve blocks. We evaluated the safety and effectiveness of the laparoscopic-guided rectus sheath block (LGRSB) for umbilical incisions after gynecologic laparoscopy.
A single-center, prospective, randomized controlled trial of 210 women who underwent gynecologic laparoscopy was performed at a university teaching hospital in Japan. The intervention group underwent the LGRSB with ropivacaine hydrochloride at the end of laparoscopy under general anesthesia and received regular care. The control group received only regular care without a field block. The postoperative pain score (PPS) was recorded at 6 and 12 h and 1, 2, and 3 days postoperatively. The PPS and use of postoperative analgesics (loxoprofen, diclofenac, and pentazocine) were recorded by the floor nurses, who were blinded to the patients' data.
In total, 107 women in the intervention group and 101 women in the control group were analyzed. No adverse events were encountered throughout this study. There was no evidence of differences in the PPS or use of perioperative opioids and postoperative analgesics.
The LGRSB for umbilical incisions after laparoscopic gynecology was easy and safe. However, this method did not significantly reduce the PPS at rest or during coughing in all postoperative conditions after gynecologic laparoscopy compared with the control.
超声引导下的神经阻滞是有效的；然而，据报道，其在腹壁中的使用与腹部器官损伤的风险相关。腹腔镜引导下的神经阻滞被认为比超声引导下的神经阻滞更安全。我们评估了腹腔镜引导下腹直肌鞘阻滞（LGRSB）在妇科腹腔镜手术后脐部切口的安全性和有效性。
在日本的一所大学教学医院进行了一项单中心、前瞻性、随机对照试验，共纳入 210 名接受妇科腹腔镜手术的女性。干预组在全身麻醉下于腹腔镜结束时接受盐酸罗哌卡因的 LGRSB，并接受常规护理。对照组仅接受常规护理，不进行局部阻滞。术后疼痛评分（PPS）在术后 6、12 小时以及 1、2 和 3 天记录。术后镇痛药物（洛索洛芬、双氯芬酸和喷他佐辛）的使用情况和 PPS 由对患者数据不知情的病房护士记录。
共分析了干预组的 107 名女性和对照组的 101 名女性。在整个研究过程中，没有发生不良事件。在 PPS 或围手术期阿片类药物和术后镇痛药物的使用方面，两组间均无差异。
腹腔镜妇科手术后行脐部切口的 LGRSB 操作简单、安全。然而，与对照组相比，这种方法并不能在妇科腹腔镜手术后的所有情况下显著降低静息时或咳嗽时的 PPS。
