Wang Shaoheng, Liu Pengfei, Gao Teng, Guan Lei, Li Tianzuo
Department of Anesthesiology, Beijing Shijitan Hospital Capital Medical University, Beijing, 10038, China.
BMC Anesthesiol. 2020 Aug 11;20(1):197. doi: 10.1186/s12871-020-01099-3.
Rectus sheath block (RSB) is known to attenuate postoperative pain and reduce perioperative opioid consumption. Thus, a retrospective study was performed to examine the effects of bilateral rectus sheath block (BRSB) in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).
A total of 178 patients undergoing CRS/HIPEC at our hospital were included. Patient information and anaesthesia-related indicators were collected from the electronic medical record (EMR) system. All subjects were divided into the following two groups: the G group (general anaesthesia) and the GR group (RSB combined with general anaesthesia). Patients in the GR group received 0.375% ropivacaine for BRSB before surgery. The primary outcomes included the total amount of remifentanil and rocuronium, the total consumption of dezocine after surgery, the visual analogue scale (VAS) score and the patient-controlled intravenous analgesia (PCIA) input dose at 1 h (T6), 6 h (T7), 12 h (T8), 24 h (T9) and 48 h (T10) after surgery. Other outcomes were also recorded, such as patient demographic data, the intraoperative heart rate (HR) and mean arterial pressure (MAP), and postoperative complications.
Compared with the G group, the GR group showed a shorter time to tracheal extubation (P < 0.05), a decreased total amount of remifentanil and rocuronium (P < 0.05), and a reduced VAS score, PCIA input dose and number of PCIA boluses at 1 h, 6 h and 12 h after surgery (P < 0.05). However, at 24 h and 48 h after surgery, there were no differences in the VAS score of pain at rest or during motion between the two groups (P > 0.05). Moreover, the incidence of hypertension, emergence agitation, delayed recovery, hypercapnia, and nausea and vomiting was lower in the GR group than in the G group (P < 0.05). There were no differences in the changes in MAP and HR during the surgery between the two groups (P > 0.05). No complications associated with nerve block occurred.
BRSB could provide short-term postoperative analgesia, reduce perioperative opioid consumption and reduce the incidence of postoperative complications. It is an effective and safe procedure in CRS/HIPEC.
已知腹直肌鞘阻滞（RSB）可减轻术后疼痛并减少围手术期阿片类药物的使用。因此，进行了一项回顾性研究，以探讨双侧腹直肌鞘阻滞（BRSB）在减瘤手术（CRS）联合热灌注化疗（HIPEC）中的效果。
纳入我院178例行CRS/HIPEC的患者。从电子病历（EMR）系统收集患者信息和麻醉相关指标。所有受试者分为以下两组：G组（全身麻醉）和GR组（RSB联合全身麻醉）。GR组患者在手术前接受0.375%罗哌卡因进行BRSB。主要结局包括瑞芬太尼和罗库溴铵的总量、术后地佐辛的总消耗量、术后1小时（T6）、6小时（T7）、12小时（T8）、24小时（T9）和48小时（T10）的视觉模拟评分（VAS）以及患者自控静脉镇痛（PCIA）输入剂量。还记录了其他结局，如患者人口统计学数据、术中心率（HR）和平均动脉压（MAP）以及术后并发症。
与G组相比，GR组气管拔管时间更短（P<0.05），瑞芬太尼和罗库溴铵总量减少（P<0.05），术后1小时、6小时和12小时的VAS评分、PCIA输入剂量和PCIA推注次数降低（P<0.05）。然而，术后24小时和48小时，两组静息或活动时疼痛的VAS评分无差异（P>0.05）。此外，GR组高血压、苏醒躁动、恢复延迟、高碳酸血症以及恶心和呕吐的发生率低于G组（P<0.05）。两组手术期间MAP和HR的变化无差异（P>0.05）。未发生与神经阻滞相关的并发症。
BRSB可提供短期术后镇痛，减少围手术期阿片类药物的使用，并降低术后并发症的发生率。在CRS/HIPEC中是一种有效且安全的方法。
