Shi De-Wen, Zhou Xiao-Dan, Wang Feng-Jie, Wang Jing, Liu Yang, Niu Yong, Xu Guang-Hong
Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, China.
Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, 218 Jixi Road, Hefei 230022, China.
J Clin Med. 2023 Feb 10;12(4):1414. doi: 10.3390/jcm12041414.
Profound trauma from laparoscopic-assisted gastrectomy (LAG) requires medication with a large number of opioids. The purpose of our study was to observe whether an incision-based rectus sheath block (IBRSB) based on the locations of the surgical incision could significantly reduce the consumption of remifentanil during LAG.
A total of 76 patients were included. The patients were prospectively randomized into two groups. Patients in group IBRSB ( = 38) received ultrasound-guided IBRSB, and the patients received 0.4% ropivacaine 40-50 mL. Patients in group C ( = 38) received the same IBRSB with 40-50 mL normal saline. The following were recorded: the consumption of remifentanil and sufentanil during surgery, pain scores at rest and during conscious activity in the post-anesthesia care unit (PACU) and at 6, 12, 24, and 48 h after surgery, and use of the patient-controlled analgesia (PCA) at 24 and 48 h after surgery.
A total of 60 participants completed the trial. The consumption of remifentanil and sufentanil in group IBRSB were significantly lower than that in group C ( < 0.001). Pain scores at rest and during conscious activity in the PACU and at 6, 12, 24, and 48 h after surgery and patients' PCA consumption within 48 h of surgery were significantly lower in group IBRSB than in group C (all < 0.05).
IBRSB based on incision multimodal anesthesia can effectively reduce the consumption of opioids during LAG, improving the postoperative analgesic effect and increasing patients' satisfaction.
腹腔镜辅助胃切除术（LAG）造成的深度创伤需要使用大量阿片类药物。本研究的目的是观察基于手术切口位置的切口腹直肌鞘阻滞（IBRSB）是否能显著减少LAG术中瑞芬太尼的用量。
共纳入76例患者。患者被前瞻性随机分为两组。IBRSB组（n = 38）接受超声引导下的IBRSB，患者接受0.4%罗哌卡因40 - 50 mL。C组（n = 38）接受相同的IBRSB，注入40 - 50 mL生理盐水。记录以下指标：术中瑞芬太尼和舒芬太尼的用量、麻醉后恢复室（PACU）以及术后6、12、24和48小时静息和清醒活动时的疼痛评分，以及术后24和48小时患者自控镇痛（PCA）的使用情况。
共有60名参与者完成试验。IBRSB组瑞芬太尼和舒芬太尼的用量显著低于C组（P < 0.001）。IBRSB组在PACU以及术后6、12、24和48小时静息和清醒活动时的疼痛评分以及术后48小时内患者PCA的用量均显著低于C组（均P < 0.05）。
基于切口的多模式麻醉下的IBRSB可有效减少LAG术中阿片类药物的用量，改善术后镇痛效果并提高患者满意度。
