腹腔镜胆囊切除术后术前与术后腹直肌鞘阻滞对急性术后疼痛缓解的影响：一项随机对照研究
Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study.
作者信息
Jeong Hye-Won, Kim Chan Sik, Choi Kyu Taek, Jeong Sung-Moon, Kim Doo-Hwan, Lee Jong-Hyuk
机构信息
Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
出版信息
J Clin Med. 2019 Jul 11;8(7):1018. doi: 10.3390/jcm8071018.
BACKGROUND
Pain after laparoscopic cholecystectomy (LC) is multifactorial and usually not effectively treated. Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision and laparoscopic surgery. We investigated the preemptive analgesic effect of RSB after LC.
METHODS
In this prospective, randomized, single-center trial, 200 patients undergoing LC were randomized into preoperative RSB (pre-RSB) or postoperative RSB (post-RSB) group. An ultrasound-guided RSB was performed before skin incision in the pre-RSB group or after skin closure in the post-RSB group. The primary outcome was total rescue analgesic consumption at 24 h post-surgery. The secondary outcomes were cumulated rescue analgesic consumption and postoperative pain measured by numerical rating scale (NRS) at 0, 1, 2, 6, 9, 18, and 24 h post-surgery.
RESULTS
Total rescue analgesic consumption at 24 h post-surgery was significantly lower in the pre-RSB group than in the post-RSB group ( = 0.020). The cumulated rescue analgesic consumption was significantly lower in the pre-RSB group than in the post-RSB group at 1 h ( = 0.023), 9 h ( = 0.020) and 18 h ( = 0.002) post-surgery. NRS was significantly lower in the pre-RSB group than in the post-RSB group at 0 h post-surgery ( = 0.023).
CONCLUSION
The pre-RSB reduced the analgesic requirements in patients undergoing LC compared with the post-RSB.
背景
腹腔镜胆囊切除术（LC）后疼痛是多因素导致的，通常难以得到有效治疗。腹直肌鞘阻滞（RSB）已被证实可减轻腹部中线切口和腹腔镜手术引起的疼痛。我们研究了LC术后RSB的超前镇痛效果。
方法
在这项前瞻性、随机、单中心试验中，200例行LC的患者被随机分为术前RSB组（pre-RSB）或术后RSB组（post-RSB）。pre-RSB组在皮肤切开前进行超声引导下的RSB，post-RSB组在皮肤缝合后进行。主要结局指标为术后24小时的总补救镇痛药物消耗量。次要结局指标为累积补救镇痛药物消耗量，以及术后0、1、2、6、9、18和24小时采用数字评分量表（NRS）测量的术后疼痛程度。
结果
术后24小时，pre-RSB组的总补救镇痛药物消耗量显著低于post-RSB组（P = 0.020）。术后1小时（P = 0.023）、9小时（P = 0.020）和18小时（P = 0.002），pre-RSB组的累积补救镇痛药物消耗量显著低于post-RSB组。术后0小时，pre-RSB组的NRS显著低于post-RSB组（P = 0.023）。
结论
与post-RSB相比，pre-RSB降低了LC患者的镇痛需求。
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