Zhao Ling, Zhang Yuxin, Chen Xinde, Zhang Chunyuan
Department of Anesthesiology, The First People's Hospital of Jiashan County, Unit 802, Building 4, Times Daguan Ruiyuan, Jiashan County, Jiaxing, 314100, Zhejiang Province, China.
Langenbecks Arch Surg. 2025 Jul 30;410(1):233. doi: 10.1007/s00423-025-03816-3.
This study is aiming at analyzing the effects of intercostal nerve block preemptive analgesia and incisional infiltration anesthesia on postoperative pain in patients undergoing laparoscopic cholecystectomy.
Ninety patients who underwent laparoscopic cholecystectomy were retrospectively selected. According to different anesthesia methods, they were allocated into an intervention group and a control group, with 45 patients in each. The control group received incisional infiltration anesthesia alone, while the intervention group received intercostal nerve block with preemptive anesthesia combined with incisional infiltration. Pain intensity was assessed using the Visual Analogue Scale (VAS) at 4, 8, 12, and 24 h postoperatively at rest, and during mobilization at 8, 12, and 24 h. Postoperative analgesia conditions, as well as the operative time, length of hospital stay, time to first ambulation, and awakening time of the two groups, were compared. The incidence of adverse events was also compared.
The intervention group reported lower resting VAS scores at 4, 8, 12, and 24 h and lower movement-related VAS scores at 8, 12, and 24 h (all P < 0.05). The number of cases with VAS ≥ 4 at 4 h, 8 h, 12 h, and 24 h postoperatively in the control group was higher than that in the intervention group (P = 0.020, 0.033, 0.034, 0.019). Moreover, the proportion of patients who did not receive additional tramadol in the intervention group was higher at 4 h, 8 h, 12 h, and 24 h postoperatively [2/13 (15.38%) vs. 2/24 (8.33%); 5/16 (31.25%) vs. 3/28 (10.71%); 7/13 (53.85%) vs. 4/26 (15.38%); 4/10 (40.00%) vs. 3/22 (13.64%)]. There was no significant difference in the operative time between the two groups (P = 0.065). The length of hospital stay, time to first ambulation, and awakening time in the intervention group were all shorter than those in the control group (P < 0.05). The incidence of adverse events did not differ significantly between groups (8.89% vs. 13.33%, P = 0.739).
Preemptive analgesia with intercostal nerve block & incisional infiltration anesthesia offers effective pain control in laparoscopic cholecystectomy, reducing the use of postoperative drugs, with a favorable safety profile.
本研究旨在分析肋间神经阻滞超前镇痛联合切口浸润麻醉对腹腔镜胆囊切除术患者术后疼痛的影响。
回顾性选取90例行腹腔镜胆囊切除术的患者。根据不同麻醉方法，将其分为干预组和对照组，每组45例。对照组仅接受切口浸润麻醉，而干预组接受肋间神经阻滞超前麻醉联合切口浸润。术后4、8、12和24小时静息时，以及8、12和24小时活动时，使用视觉模拟评分法（VAS）评估疼痛强度。比较两组的术后镇痛情况、手术时间、住院时间、首次下床活动时间和苏醒时间。同时比较不良事件的发生率。
干预组在术后4、8、12和24小时的静息VAS评分较低，在8、12和24小时的活动相关VAS评分也较低（均P < 0.05）。对照组术后4、8、12和24小时VAS≥4的病例数高于干预组（P = 0.020、0.033、0.034、0.019）。此外，干预组术后4、8、12和24小时未接受额外曲马多治疗的患者比例更高[2/13（15.38%）对2/24（8.33%）；5/16（31.25%）对3/28（10.71%）；7/13（53.85%）对4/26（15.38%）；4/10（40.00%）对3/22（13.64%）]。两组手术时间差异无统计学意义（P = 0.065）。干预组的住院时间、首次下床活动时间和苏醒时间均短于对照组（P < 0.05）。两组不良事件发生率差异无统计学意义（8.89%对13.33%，P = 0.739）。
肋间神经阻滞联合切口浸润麻醉超前镇痛在腹腔镜胆囊切除术中能有效控制疼痛，减少术后药物使用，安全性良好。
