脊髓麻醉、宫颈旁阻滞和全身麻醉对诊断性宫腔镜检查中疼痛、恶心呕吐及镇痛需求的影响比较：一项非随机临床试验
Comparison of the effects of spinal anesthesia, paracervical block and general anesthesia on pain, nausea and vomiting, and analgesic requirements in diagnostic hysteroscopy: A non-randomized clinical trial.
作者信息
Manouchehrian Nahid, Pilehvari Shamim, Rahimi-Bashar Farshid, Esna-Ashari Farzaneh, Mohammadi Shaghayegh
机构信息
Department of Anesthesiology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamedan, Iran.
Department of Gynecology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamedan, Iran.
出版信息
Front Med (Lausanne). 2023 Mar 1;10:1089497. doi: 10.3389/fmed.2023.1089497. eCollection 2023.
BACKGROUND
The aim of this study was to compare the effect of spinal anesthesia (SPA), paracervical block (PB), and general anesthesia (GA), on pain, the frequency of nausea and vomiting and analgesic requirements in diagnostic hysteroscopy.
METHODS
This single-center, non-randomized, parallel-group, clinical trial was conducted on 66 diagnostic hysteroscopy candidates who were selected by convenience sampling at Fatemieh Hospital, in Hamadan, Iran, in 2021.
RESULTS
The mean pain score during recovery and the need for analgesic injections was found to be significantly higher in the GA group compared to that in the SPA group (pain: 3.77 ± 2.25 vs. 0.10 ± 0.30, < 0.001), (analgesic: 50 vs. 0%, < 0.001) and PB group (pain: 3.77 ± 2.25 vs. 0.90 ± 1.37, < 0.001), (analgesic 50 vs. 10%, < 0.001), respectively. However, no statistically significant difference was observed between the mean pain score between SPA and PB groups (0.10 ± 0.30 vs. 0.90 ± 1.3, = 0.661). In addition, there were no significant differences between groups on nausea/vomiting after operation ( = 0.382). In adjusted regression analysis (adjusting for age, weight, gravid, abortion, and cause of hysteroscopy), the odds ratio (OR) of pain score during recovery was increased in PB (OR: 4.471, 95% CI: 1.527-6.156, = 0.018) and GA (OR: 8.406, 95% CI: 2.421-9.195, = 0.001) groups compared with the SPA group. However, in adjusting based on times of surgery duration, anesthesia duration, recovery and return of motor function, the ORs of pain score between groups was not statistically significant.
CONCLUSION
Despite reduced pain during recovery in patients receiving SPA, duration of anesthesia, recovery period, and return of motor function were significantly prolonged compared to those receiving PB or GA. It seems that PB with less recovery time and faster return of motor function than SPA and also mild pain during recovery compared to GA can be a good option for hysteroscopy.
CLINICAL TRIAL REGISTRATION
http://www.irct.ir, identifier IRCT20120915010841N26.
背景
本研究旨在比较脊髓麻醉（SPA）、宫颈旁阻滞（PB）和全身麻醉（GA）对诊断性宫腔镜检查中疼痛、恶心呕吐频率及镇痛需求的影响。
方法
2021年，在伊朗哈马丹的法特米耶医院，通过便利抽样法选取了66名拟行诊断性宫腔镜检查的患者，进行了这项单中心、非随机、平行组临床试验。
结果
与SPA组相比，GA组恢复期间的平均疼痛评分及镇痛注射需求显著更高（疼痛：3.77±2.25 vs. 0.10±0.30，P<0.001），（镇痛：50% vs. 0%，P<0.001）；与PB组相比，GA组恢复期间的平均疼痛评分及镇痛注射需求也显著更高（疼痛：3.77±2.25 vs. 0.90±1.37，P<0.001），（镇痛：50% vs. 10%，P<0.001）。然而，SPA组和PB组之间的平均疼痛评分无统计学显著差异（0.10±0.30 vs. 0.90±1.3，P = 0.661）。此外，术后恶心/呕吐情况在各组之间无显著差异（P = 0.382）。在调整回归分析（校正年龄、体重、妊娠、流产及宫腔镜检查原因）中，与SPA组相比，PB组（比值比[OR]：4.471，95%置信区间[CI]：1.527 - 6.156，P = 0.018）和GA组（OR：8.406，95% CI：2.421 - 9.195，P = 0.001）恢复期间疼痛评分的比值比升高。然而，在校正手术持续时间、麻醉持续时间、恢复及运动功能恢复时间后，各组间疼痛评分的比值比无统计学显著差异。
结论
尽管接受SPA的患者恢复期间疼痛减轻，但与接受PB或GA的患者相比，麻醉持续时间、恢复期及运动功能恢复时间显著延长。与SPA相比，PB恢复时间更短、运动功能恢复更快，与GA相比，PB恢复期间疼痛较轻，似乎是宫腔镜检查的一个良好选择。
临床试验注册
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