Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Koç University School of Medicine, Istanbul, Turkey.
Medicine (Baltimore). 2024 Oct 25;103(43):e40176. doi: 10.1097/MD.0000000000040176.
With the growing adoption of robotic techniques in gynecologic surgery, the advantages of minimally invasive procedures over traditional open surgery, such as reduced postoperative pain and quicker recovery, are clear. Yet, establishing an effective multimodal analgesic regimen remains a challenge. This retrospective study from a tertiary care center aimed to assess the analgesic efficacy of the rectus sheath block (RSB) on postoperative pain and opioid consumption after robotic gynecologic surgery. Between June 2022 and March 2023, 20 patients who underwent robotic gynecologic surgery were evaluated. Key parameters included postoperative visual analog scale scores, opioid consumption, and postoperative nausea/vomiting instances. Anesthesia protocols were standardized, with postsurgical pain management involving RSB and a patient-controlled analgesia device filled with morphine. Patients showed an average morphine intake of 8.2 ± 5.09 mg over the initial 24 hours postsurgery. During mobilization, average pain scores were consistently low, with no correlation identified between opioid consumption and age or body mass index. 40% of patients reported postoperative nausea on the first day, and no complications linked to the RSB were observed. The study underlines the potential of integrating RSB in a multimodal analgesic regimen after robotic gynecologic surgery. Its application may lead to reduced opioid consumption and more efficient postoperative pain management. Further randomized controlled trials are recommended to validate these findings.
随着机器人技术在妇科手术中的应用日益普及，微创手术相对于传统开放手术的优势（如术后疼痛减轻和恢复更快）显而易见。然而，建立有效的多模式镇痛方案仍然是一个挑战。本研究来自一家三级保健中心，旨在评估腹直肌鞘阻滞（RSB）在机器人妇科手术后的镇痛效果和阿片类药物的消耗。在 2022 年 6 月至 2023 年 3 月期间，评估了 20 名接受机器人妇科手术的患者。主要参数包括术后视觉模拟评分、阿片类药物消耗和术后恶心/呕吐的发生情况。麻醉方案标准化，术后疼痛管理包括 RSB 和填充吗啡的患者自控镇痛装置。患者在术后 24 小时内平均摄入 8.2±5.09mg 吗啡。在活动期间，平均疼痛评分一直较低，阿片类药物消耗与年龄或体重指数之间没有相关性。40%的患者在第一天报告了术后恶心，没有观察到与 RSB 相关的并发症。该研究强调了在机器人妇科手术后的多模式镇痛方案中整合 RSB 的潜力。其应用可能导致阿片类药物消耗减少和更有效的术后疼痛管理。建议进行更多的随机对照试验来验证这些发现。
