Department of Anesthesiology, VKV American Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Koç University, School of Medicine, Istanbul, Turkey.
Medicine (Baltimore). 2024 Apr 26;103(17):e37975. doi: 10.1097/MD.0000000000037975.
Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations.
This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded.
Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points.
RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.
即使是在微创机器人辅助腹腔镜根治性前列腺切除术后，术后疼痛仍然是一个重要问题，这会导致术后不适，有时还会延长住院时间。在术后疼痛管理中，除了全身镇痛药外，还采用了区域麻醉和镇痛技术，多模式方法。超声引导的筋膜平面阻滞在微创外科中变得越来越重要。另一个引起不适的重要原因是导尿管疼痛。本随机对照研究调查了腹直肌鞘阻滞对机器人前列腺切除术术后疼痛和与导尿管相关的膀胱不适的影响。
本随机对照试验于 2022 年 3 月至 8 月进行。所有参与者均获得书面知情同意。该研究获得了临床研究伦理委员会的批准。所有个体均提供了书面知情同意书，计划接受全身麻醉下机器人前列腺切除术的美国麻醉医师协会身体状况分类 I 至 III 级的成年人被纳入研究。在计算机辅助随机分组后，患者分为 2 组，所有患者均在全身麻醉下进行诱导。在全身麻醉下和手术结束时进行腹直肌鞘阻滞。非腹直肌鞘阻滞（RSB）组的患者未应用筋膜平面阻滞。术后疼痛和导尿管疼痛使用数字评分量表进行评估。在恢复室计划芬太尼作为解救性镇痛。如果数字评分量表评分为 4 或更高，患者将给予 50 µg IV 芬太尼，如果需要，可重复使用。在恢复室中记录给予的芬太尼总剂量。所有患者均计划接受 IV 吗啡患者自控镇痛。记录所有患者在术后恢复室和病房（术后 3、6、12 和 24 小时）的疼痛评分（手术部位疼痛和尿道导管不适）和总吗啡消耗量。
共评估了 61 名患者。非 RSB 组在病房随访期间的曲马多总消耗量明显更高。非 RSB 组在麻醉后护理单元的芬太尼消耗量明显更高。RSB 组在 0 至 12 小时和 12 至 24 小时时吗啡总消耗量明显更低。RSB 组的总阿片类药物消耗量为 8.81mg，非 RSB 组为 19.87mg。RSB 组在所有时间点的尿道导管疼痛均明显减轻。
RSB 通过显著减少机器人前列腺切除术的术后阿片类药物消耗，显示出有效的镇痛效果。
