精索阻滞对降低显微外科腹股沟下精索静脉曲张切除术期间迷走神经反射风险的影响：一项随机试验。
The effect of spermatic cord block on reducing the risk of vagal reflex during microsurgical subinguinal varicocelectomy: A randomized trial.
作者信息
Gao Qing-Qiang, Wu Ning, Li Yuan-Zhi, Dai Yu-Tian
机构信息
Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Department of Urology, The People's Hospital of Jiaozuo, Jiaozuo, China.
出版信息
Heliyon. 2024 Jul 9;10(14):e34414. doi: 10.1016/j.heliyon.2024.e34414. eCollection 2024 Jul 30.
PURPOSE
This study aimed to compare the risk of vagal reflex during microsurgical subinguinal varicocelectomy (MSV) under general anesthesia (GA) with or without additional local anesthetic (LA) spermatic cord block (SCB).
METHOD
A single-center randomized controlled trial was conducted between January 2022 and June 2023.300 patients with left-sided grade Ⅲ varicocele were randomly divided into two groups: SCB group (n = 153) and control group (n = 147)（computer-generated random numbers list）. During MSV under GA, the SCB group was given of ropivacaine for SCB before pulling the spermatic cord, while the control group was directly lifted. The primary outcome was the reduction in the lowest heart rate in the SCB group as compared with the control group during spermatic cord traction (SCT). Secondary outcomes included the reduction in the lowest blood pressure in the SCB group as compared with the control group; and the reductions in the lowest heart rate and lowest blood pressure as compared with baseline during SCT. The number of times that surgery and medications were suspended because of symptomatic reflex bradycardia was also recorded. Adverse events were also recorded as secondary outcomes.
RESULT
Five patients in the SCB group and 10 patients in the CG were excluded. The lowest heart rate and systolic blood pressure during SCT in the SCB group and the control group were significantly lower than the baseline values (P < 0.05). However, the decrease in the SCB group (70-73bpm VS 108-115 mmHg) was milder than that of the control group（66-72 bpm VS 105-114 mmHg）(P < 0.05). The number of surgeries and medication pauses due to symptomatic reflex bradycardia during surgery was significantly lower in the SCB group (2 VS 1) than in the control group (9 VS 7) (P < 0.05).
CONCLUSION
SCB can effectively reduce the vagal reflex caused by pulling the spermatic cord during MSV, and reduce the risk of anesthesia and surgery.
目的
本研究旨在比较全身麻醉（GA）下显微外科腹股沟下精索静脉曲张切除术（MSV）时，使用或不使用额外局部麻醉（LA）精索阻滞（SCB）情况下迷走神经反射的风险。
方法
于2022年1月至2023年6月进行了一项单中心随机对照试验。300例左侧Ⅲ级精索静脉曲张患者被随机分为两组：SCB组（n = 153）和对照组（n = 147）（计算机生成随机数字列表）。在GA下进行MSV期间，SCB组在牵拉精索前给予罗哌卡因进行SCB，而对照组直接进行手术。主要结局是SCB组与对照组在精索牵引（SCT）期间最低心率的降低情况。次要结局包括SCB组与对照组最低血压的降低情况；以及SCT期间与基线相比最低心率和最低血压的降低情况。还记录了因症状性反射性心动过缓而暂停手术和用药的次数。不良事件也作为次要结局进行记录。
结果
SCB组有5例患者和CG组有10例患者被排除。SCB组和对照组在SCT期间的最低心率和收缩压均显著低于基线值（P < 0.05）。然而，SCB组的降低幅度（70 - 73次/分对108 - 115 mmHg）比对照组（66 - 72次/分对105 - 114 mmHg）更轻微（P < 0.05）。SCB组手术期间因症状性反射性心动过缓导致的手术和用药暂停次数（2次对1次）显著低于对照组（9次对7次）（P < 0.05）。
结论
SCB可有效降低MSV期间牵拉精索引起的迷走神经反射，并降低麻醉和手术风险。
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