Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
University of Milano-Bicocca, Monza, Italy.
Int J Gynaecol Obstet. 2024 Sep;166(3):1240-1246. doi: 10.1002/ijgo.15483. Epub 2024 Mar 22.
Enhanced recovery after surgery (ERAS) protocols have been introduced in gynecology. Postoperative pain management after vaginal procedures remains a relevant issue. In the present study we aimed to evaluate the effectiveness of pre-emptive uterosacral/cervical block (PUCB) for postoperative pain control in patients with uterovaginal prolapse undergoing vaginal hysterectomy and pelvic floor repair. We also evaluated the impact on the length of recovery.
This was a pilot study analyzing 40 women who underwent pelvic organ prolapse repair through uterosacral ligament suspension. Patients who chose to undergo PUCB were considered as cases, otherwise as controls. After general or spinal anesthesia induction, the treatment group received the PUCB with ropivacaine plus clonidine injections at 2, 4, 8, and 10 o'clock of the cervix. The control group did not receive additional treatment. Pain intensity was measured at rest and after forceful cough at 1, 4, 8, 12, 24, and 48 h postoperatively.
We found a significant reduction in pain values at 1 h (rest and forceful cough) and 24 h (forceful cough) in the PUCB group. The incidence of moderate/severe pain was inferior in the PUCB group at 1 h (rest) and 24 h (rest and forceful cough). There were no differences in terms of the use of rescue opioids (0% vs. 5%; P = 0.311) and length of hospital stay (2.5 ± 0.6 vs. 2.3 ± 0.6; P = 0.180).
For the first time, we demonstrated the impact of pre-emptive uterosacral/cervical block on pain control up to 24 h after surgery. Clonidine as a sensory blockade extender appears promising in enhancing the efficacy of local anesthetics.
外科手术后加速康复（ERAS）方案已在妇科中引入。阴道手术后的疼痛管理仍然是一个相关问题。在本研究中，我们旨在评估预防性子宫骶骨/宫颈阻滞（PUCB）在接受阴道子宫切除术和盆底修复的子宫阴道脱垂患者中控制术后疼痛的效果。我们还评估了其对恢复时间的影响。
这是一项试点研究，分析了 40 名接受子宫骶骨韧带悬吊术治疗的盆腔器官脱垂患者。选择接受 PUCB 的患者被视为病例，否则为对照组。在全身或脊髓麻醉诱导后，治疗组在宫颈 2、4、8 和 10 点接受罗哌卡因加可乐定注射的 PUCB。对照组未接受额外治疗。术后 1、4、8、12、24 和 48 小时分别测量静息和用力咳嗽时的疼痛强度。
我们发现，在 1 小时（静息和用力咳嗽）和 24 小时（用力咳嗽）时，PUCB 组的疼痛值显著降低。在 1 小时（静息）和 24 小时（静息和用力咳嗽）时，PUCB 组中度/重度疼痛的发生率较低。在使用解救性阿片类药物方面（0% vs. 5%；P=0.311）和住院时间方面（2.5±0.6 vs. 2.3±0.6；P=0.180）均无差异。
我们首次证明了预防性子宫骶骨/宫颈阻滞对术后 24 小时内疼痛控制的影响。可乐定作为感觉阻滞延伸剂，似乎有望增强局部麻醉剂的疗效。
