两种剂量罗哌卡因单次脊麻对男性痔切除术后尿潴留的影响
Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients.
作者信息
Wang Lei-Lei, Kang Meng, Duan Li-Xin, Chang Xu-Fei, Li Xiao-Xin, Guo Xiang-Yang, Kang Zhi-Yu, Han Yong-Zheng
机构信息
Department of Anesthesiology, Peking University Third Hospital Yanqing Hospital, Beijing, China.
Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
出版信息
Front Surg. 2023 Jan 11;9:1077575. doi: 10.3389/fsurg.2022.1077575. eCollection 2022.
BACKGROUND
Anorectal diseases are common in the population and include internal, external, and mixed hemorrhoids. Although hemorrhoid surgery is a brief operation, anesthesia, anesthetic drugs, drug concentrations, and anesthesia level control are closely related to postoperative uroschesis. For hemorrhoid surgery, a single spinal block with ropivacaine is commonly used that blocks the S2-S4 parasympathetic nervous system, which in turn governs the voiding reflex, causing postoperative urinary retention; this affects the recovery of patients. This study was performed to investigate the effects of two doses ropivacaine that provided satisfactory analgesia and muscle relaxation and inhibited adverse reflexes on urinary retention after hemorrhoidectomy.
METHODS
The study included 200 male patients who underwent anorectal surgery with American Society of Anesthesiologists (ASA) grade I-II single elective spinal anesthesia between March 2021 and March 2022. Patients were randomly assigned to 2 groups using a random number table: Group A ( = 100) received 10 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml), and Group B ( = 100) received 15 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml).
RESULTS
The anal sphincter exhibited good relaxation, and no obvious traction pain or significant difference in the time of muscle strength recovery was observed between the 10 mg and 15 mg 0.5% ropivacaine groups (> 0.05). The 10 mg 0.5% ropivacaine group had shorter time of micturition exceeding 100 ml and lower voiding International Prostate Symptom Score than the 15 mg 0.5% ropivacaine group (< 0.01).
CONCLUSIONS
Single spinal anesthesia with 10 mg 0.5% ropivacaine not only provides satisfactory anesthetic effect for hemorrhoidectomy but also has less influence on postoperative uroschesis and is worthy of clinical application.
TRIAL REGISTRATION
The study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR2,100,043,686) on February 27, 2021.
背景
肛肠疾病在人群中很常见，包括内痔、外痔和混合痔。尽管痔疮手术是一种简短的手术，但麻醉、麻醉药物、药物浓度和麻醉水平控制与术后尿潴留密切相关。对于痔疮手术，常用罗哌卡因单次腰麻，其阻断S2 - S4副交感神经系统，进而支配排尿反射，导致术后尿潴留；这影响患者的恢复。本研究旨在探讨两种剂量的罗哌卡因对痔疮切除术后尿潴留的影响，这两种剂量能提供满意的镇痛和肌肉松弛效果并抑制不良反射。
方法
本研究纳入200例男性患者，他们在2021年3月至2022年3月期间接受了美国麻醉医师协会（ASA）I - II级的单选择性腰麻下的肛肠手术。使用随机数字表将患者随机分为2组：A组（n = 100）接受10mg 0.5%罗哌卡因（1.5ml 1%罗哌卡因 + 1.5ml 10%葡萄糖 = 3ml），B组（n = 100）接受15mg 0.5%罗哌卡因（1.5ml 1%罗哌卡因 + 1.5ml 10%葡萄糖 = 3ml）。
结果
肛门括约肌松弛良好，10mg和15mg 0.5%罗哌卡因组之间未观察到明显的牵拉痛或肌肉力量恢复时间的显著差异（>0.05）。10mg 0.5%罗哌卡因组排尿超过100ml的时间比15mg 0.5%罗哌卡因组短，排尿国际前列腺症状评分也更低（<0.01）。
结论
10mg 0.5%罗哌卡因单次腰麻不仅为痔疮切除术提供了满意的麻醉效果，而且对术后尿潴留的影响较小，值得临床应用。
试验注册
该研究于2021年2月27日在中国临床试验注册中心（http://www.chictr.org.cn；标识符：ChiCTR2100043686）注册。
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