Bae Myung Il, Kang Sang-Wook, Lee Jong Seok, Kim Na Young, Lee Bahn, Moon Gilseong, Yoo Young Chul, Nam Kee-Hyun
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
J Clin Med. 2023 May 23;12(11):3633. doi: 10.3390/jcm12113633.
The occurrence of significant pain and paresthesia after robot-assisted transaxillary thyroidectomy has been reported, and some patients experience chronic symptoms even three months after surgery. This study scrutinized the effects of deep neuromuscular block during robot-assisted transaxillary thyroidectomy on postoperative pain and sensory changes. In this single-blinded, prospective, randomized, controlled trial, 88 patients who underwent robot-assisted transaxillary thyroidectomy were enrolled and randomly allocated to either the moderate or deep neuromuscular block groups. Study endpoints included postoperative pain, paresthesia, and sensory change after surgery. The linear mixed models for numeric rating scale pain scores in the chest, neck, and axilla all showed significant intergroup differences over time ( = 0.003 in chest; = 0.001 in neck; = 0.002 in axilla). In the post hoc analysis with Bonferroni correction, the pain scores of the chest, neck, and axilla were significantly lower in the deep neuromuscular block group on postoperative day one compared to the moderate neuromuscular block group (adjusted < 0.001 in chest, neck, and axilla). This study demonstrated that deep neuromuscular block could reduce postoperative pain after robot-assisted transaxillary thyroidectomy. However, it could not demonstrate that deep neuromuscular block reduces paresthesia or hypoesthesia after the surgery.
已有报道称机器人辅助经腋窝甲状腺切除术后出现显著疼痛和感觉异常，一些患者甚至在术后三个月仍有慢性症状。本研究仔细观察了机器人辅助经腋窝甲状腺切除术中深度神经肌肉阻滞对术后疼痛和感觉变化的影响。在这项单盲、前瞻性、随机对照试验中，88例行机器人辅助经腋窝甲状腺切除术的患者被纳入研究，并随机分为中度或深度神经肌肉阻滞组。研究终点包括术后疼痛、感觉异常和术后感觉变化。胸部、颈部和腋窝数字评分量表疼痛评分的线性混合模型均显示，随着时间推移组间存在显著差异（胸部P = 0.003；颈部P = 0.001；腋窝P = 0.002）。在采用Bonferroni校正的事后分析中，与中度神经肌肉阻滞组相比，深度神经肌肉阻滞组术后第一天胸部、颈部和腋窝的疼痛评分显著更低（校正后胸部、颈部和腋窝P < 0.001）。本研究表明，深度神经肌肉阻滞可减轻机器人辅助经腋窝甲状腺切除术后的疼痛。然而，它未能证明深度神经肌肉阻滞可减少术后感觉异常或感觉减退。
