Shao Peiqi, Jiang Jia, Shi Rong, Hu Jinge, Li Huili, Guo Ruijuan, Wang Yun
Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
J Clin Anesth. 2025 Jun;104:111864. doi: 10.1016/j.jclinane.2025.111864. Epub 2025 May 9.
This study aimed to evaluate the efficacy of the combination of ultrasound-guided transversus abdominis plane block (TAPB) and a novel anterior approach of sacral plexus block (SPB) on postoperative pain following laparoscopic radical prostatectomy.
Double-blinded, prospective, randomized study.
University-affiliated tertiary care hospital.
Ninety patients aged 40 to 80 years with American Society of Anesthesiologists (ASA) physical status of I-III scheduled to undergo elective laparoscopic radical prostatectomy under general anesthesia.
Patients were randomized to receive TAPB alone (Control group) or the combination of TAPB and anterior approach of SPB (SPB group).
The primary outcome was cumulative intravenous morphine equivalent consumption at 24 h postoperatively. Secondary outcomes included pain scores, the incidence and severity of catheter-related bladder discomfort, patient satisfaction for analgesia, rescue analgesia requirement, time to first patient-controlled analgesia (PCA) demand, the incidence of side effects, and clinical recovery.
The median (interquartile range [IQR]) intravenous morphine equivalent was 28 (24, 30) mg in the SPB group compared with the control group, which had a median (IQR) of 34 (30, 41) mg. The median difference of -6 (95 % confidence interval, -8 to -4, P<0.001) was statistically different but not clinically important. The incidence of catheter-related bladder discomfort at 1 h, 4 h and 8 h after surgery were significantly lower in the SPB group. The SPB decreased the pain scores at 1 h postoperatively, prolonged the time to first PCA demand, and increased the Quality of Recovery-15 score at 48 h postoperatively. No significant differences were observed in satisfaction scores, the requirement for rescue analgesia, time to first flatus and ambulation, and the incidence of adverse effects.
The addition of the anterior approach of SPB was not superior to TAPB alone in reducing opioid consumption for laparoscopic radical prostatectomy. However, it was associated with lower early postoperative pain scores, decreased incidence of catheter-related bladder discomfort, and improved quality of recovery.
本研究旨在评估超声引导下腹横肌平面阻滞（TAPB）联合一种新型骶丛神经阻滞（SPB）前路法对腹腔镜前列腺癌根治术后疼痛的疗效。
双盲、前瞻性、随机研究。
大学附属三级护理医院。
90例年龄在40至80岁之间、美国麻醉医师协会（ASA）身体状况为I - III级、计划在全身麻醉下接受择期腹腔镜前列腺癌根治术的患者。
患者被随机分为单纯接受TAPB组（对照组）或TAPB联合SPB前路法组（SPB组）。
主要结局指标为术后24小时静脉注射吗啡等效剂量的累计消耗量。次要结局指标包括疼痛评分、导尿管相关膀胱不适的发生率和严重程度、患者对镇痛的满意度、补救镇痛需求、首次患者自控镇痛（PCA）需求时间、副作用发生率及临床恢复情况。
SPB组静脉注射吗啡等效剂量的中位数（四分位间距[IQR]）为28（24，30）mg，而对照组为34（30，41）mg。中位数差值为 - 6（95%置信区间， - 8至 - 4，P < 0.001），具有统计学差异，但无临床意义。SPB组术后1小时、4小时和8小时导尿管相关膀胱不适的发生率显著较低。SPB降低了术后1小时的疼痛评分，延长了首次PCA需求时间，并提高了术后48小时的恢复质量 - 15评分。在满意度评分、补救镇痛需求、首次排气和下床活动时间以及不良反应发生率方面未观察到显著差异。
对于腹腔镜前列腺癌根治术，添加SPB前路法在减少阿片类药物消耗方面并不优于单纯TAPB。然而，它与术后早期较低的疼痛评分、导尿管相关膀胱不适发生率降低以及恢复质量改善相关。
