Khater Nazih, Comardelle Nicholas Joseph, Domingue Natalie M, Borroto Wilfredo J, Cornett Elyse M, Imani Farnad, Rajabi Mehdi, Kaye Alan D
Department of Urology, Louisiana State University, Shreveport, LA, USA.
School of Medicine, Louisiana State University, Shreveport, LA, USA.
Anesth Pain Med. 2022 Jul 25;12(3):e127911. doi: 10.5812/aapm-127911. eCollection 2022 Jun.
Robotic surgery is becoming the most common approach in minimally invasive urologic procedures. Robotic surgery offers less pain to patients because of smaller keyhole incisions and less tissue retraction and stretching of fascia and muscular fibers. Tailored pain regimens have also evolved and allowed patients to feel minimal to no discomfort after robotic urologic surgery, allowing in parallel better surgical outcomes. This study aims to analyze the most current pain regimens in robotic urologic surgery and to evaluate the most current pain protocols and corresponding outcomes.
A literature review was performed of published manuscripts utilizing Pubmed and Google Scholar on pain protocols for patients undergoing robotic urologic surgery.
Multimodal analgesia is gaining ground in robotic urologic surgery. Regional analgesia includes four major modalities: Neuroaxial analgesia, intercostal blocks, tranvsersus abdominis plane blocks, and paravertebral blocks. Each approach has a different injection site, region of analgesia coverage, and duration of coverage depending upon local anesthesia and/or adjuvant utilized with advantages and disadvantages that make each modality unique and efficacious.
Robotic urologic surgery has offered the advantage of smaller incisions, faster recovery, less postoperative opioid consumption, and better surgical outcomes. Neuraxial, intercostal, transversus abdominis plane, and quadratus lumborum blocks are the best and most adopted approaches which offer optimal outcomes to patients.
机器人手术正成为微创泌尿外科手术中最常用的方法。由于切口更小、对筋膜和肌肉纤维的组织牵拉更少，机器人手术给患者带来的疼痛更小。量身定制的疼痛管理方案也不断发展，使患者在机器人泌尿外科手术后感到最小程度的不适甚至没有不适，同时带来更好的手术效果。本研究旨在分析机器人泌尿外科手术中最新的疼痛管理方案，并评估最新的疼痛治疗方案及相应结果。
利用PubMed和谷歌学术对已发表的关于机器人泌尿外科手术患者疼痛治疗方案的手稿进行了文献综述。
多模式镇痛在机器人泌尿外科手术中越来越普遍。区域镇痛包括四种主要方式：神经轴索镇痛、肋间阻滞、腹横肌平面阻滞和椎旁阻滞。每种方法根据所使用的局部麻醉和/或辅助药物的不同，注射部位、镇痛覆盖区域和覆盖持续时间也不同，各有优缺点，使得每种方式都具有独特性和有效性。
机器人泌尿外科手术具有切口小、恢复快、术后阿片类药物用量少和手术效果好等优点。神经轴索、肋间、腹横肌平面和腰方肌阻滞是为患者带来最佳效果的最常用且最佳的方法。
