Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia.
Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Int J Colorectal Dis. 2022 Mar;37(3):665-672. doi: 10.1007/s00384-022-04094-x. Epub 2022 Feb 4.
To evaluate the postoperative outcomes of a multimodal perioperative pain management protocol with rectus sheath blocks (RSBs) or intrathecal morphine (ITM) injection for minimally invasive colorectal cancer surgery.
A total of 112 patients underwent minimally invasive colorectal surgery. Forty-one patients underwent RSB (group 1), whereas 71 patients underwent ITM (group 2) in addition to multimodal pain management using enhanced recovery after the surgery protocol. To adjust for the baseline differences and selection bias, baseline characteristics and postoperative outcomes were compared using propensity score matching.
Forty patients were evaluated in each group. There was no significant difference in the length of hospital stay between the two groups. According to the Comprehensive Complication Index (CCI) score, the postoperative complication rate was significantly lower in the RSB group (3.0 ± 7.8) than in the ITM group (8.1 ± 10.9; p = 0.016). During the first 24 h after surgery, the median postoperative visual analog scale score was significantly higher in the RSB group than in the ITM group (2.0 ± 1.1 vs. 1.5 ± 1.2; p = 0.048). Postoperative morphine use was also significantly higher in the RSB group than in the ITM group in the first 24 h (23.7 ± 19.8 vs 11.6 ± 15.6%; p = 0.003) and 48 h (16.9 ± 24.8 vs. 7.5 ± 11.9; p = 0.036) after surgery. Significant urinary retention occurred after the in the RSB and ITM groups (5% vs. 45%; p < 0.001).
Although the RSB group had higher morphine use during the first 48 h after surgery, the length of hospital stay remained the same and the complications were less in terms of the CCI score. Thus, transperitoneal RSB is a safe and feasible approach for postoperative pain management following minimally invasive procedures.
评估腹直肌鞘阻滞（RSB）或鞘内吗啡（ITM）注射联合术后多模式镇痛方案在微创结直肠手术中的术后转归。
共纳入 112 例行微创结直肠手术的患者。41 例患者接受 RSB（组 1），71 例患者接受 ITM（组 2），同时还采用术后加速康复方案进行多模式疼痛管理。为了调整基线差异和选择偏倚，采用倾向评分匹配比较两组患者的基线特征和术后转归。
每组有 40 例患者接受评估。两组患者的住院时间无显著差异。根据综合并发症指数（CCI）评分，RSB 组的术后并发症发生率（3.0±7.8）显著低于 ITM 组（8.1±10.9；p=0.016）。术后 24 h 内，RSB 组患者术后视觉模拟评分（VAS）中位数显著高于 ITM 组（2.0±1.1 比 1.5±1.2；p=0.048）。术后 24 h 内，RSB 组患者吗啡用量也显著高于 ITM 组（23.7±19.8 比 11.6±15.6%；p=0.003），术后 48 h 内吗啡用量也显著高于 ITM 组（16.9±24.8 比 7.5±11.9；p=0.036）。RSB 组和 ITM 组均出现显著的尿潴留（5%比 45%；p<0.001）。
虽然 RSB 组术后 48 h 内吗啡用量较高，但住院时间保持不变，CCI 评分显示并发症较少。因此，经腹 RSB 是微创术后一种安全可行的术后镇痛方法。
