Application of incision-based precision multipoint rectus sheath block and bilateral rectus sheath block in laparoscopic-assisted colorectal surgery: a randomized, controlled trial.

IF 2.7 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Sihui Zhu, Xin Da, Jiawei Wang, Yulu Hu, Xinyue Wang, Yang Liu, Guanghong Xu
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引用次数: 0

Abstract

Background: This study evaluated whether the innovative multipoint incision-based rectus sheath block (IBRSB) tailored to surgical site and trauma level, could reduce opioid use and improve analgesia in laparoscopic-assisted colorectal surgery (LACS) compared to bilateral rectus sheath block (RSB).

Methods: A total of 72 patients undergoing LACS, with quantium consciousness index monitoring were randomized to receive either IBRSB or bilateral RSB using 40 ml of 0.4% ropivacaine (n = 36 for both). The primary outcome was intraoperative dosage of remifentanil.

Results: Seventy patients completed the study, with 35 in each group. The IBRSB group had significantly lower remifentanil use (mean [SD]: 4.42 [2.01] vs 5.92 [2.53] μg/kg/h; 95% confidence intervals: -2.59 to -0.41; P = 0.008) and less postoperative sufentanil use via patient-controlled intravenous analgesia within 24 h. Intraoperative hemodynamics were more stable in the IBRSB group. Pain scores at rest and with movement similar between groups at all six postoperative time points. No block-related complications occurred.

Conclusion: Compared to bilateral RSB, IBRSB based on incision location and trauma severity significantly reduced intraoperative and postoperative opioid requirements, improved hemodynamic stability, and showed no increase in complications in patients undergoing LACS. Key messages What is already known on this topic: Laparoscopic surgery requires small midline incisions and multiple trocars, resulting in scattered wounds. An incision-based precision multipoint rectus sheath block (RSB), tailored to the surgical site and providing dual analgesia through local infiltration and nerve blockade, may be more suitable for laparoscopic-assisted colorectal surgery than bilateral RSB. What this study adds: The main finding was that ultrasound-guided incision-based precision multipoint RSB, compared to bilateral RSB, significantly reduced intraoperative and postoperative morphine equivalents in patients undergoing laparoscopic-assisted colorectal surgery. How this study might affect research, practice, or policy: The incision-based precision multipoint represents a safe and efficacious technique, which is recommended for routine implementation in patients subjected to laparoscopic-assisted colorectal surgery.

基于切口的精确多点直肌鞘阻滞和双侧直肌鞘阻滞在腹腔镜辅助结直肠手术中的应用:一项随机对照试验。
背景:本研究评估了与双侧直肌鞘阻滞(RSB)相比,针对手术部位和创伤程度量身定制的创新型多点切口直肌鞘阻滞(IBRSB)是否能减少腹腔镜辅助结直肠手术(LACS)中阿片类药物的使用并改善镇痛。方法:对72例LACS患者进行定量意识指数监测,随机分为IBRSB组和双侧RSB组,分别使用0.4%罗哌卡因40 ml(各36例)。主要观察指标为术中瑞芬太尼用量。结果:70例患者完成研究,每组35例。IBRSB组的瑞芬太尼用量明显降低(平均[SD]: 4.42 [2.01] vs 5.92 [2.53] μg/kg/h; 95%可信区间:-2.59 ~ -0.41;P = 0.008),术后24 h内患者自行静脉镇痛的舒芬太尼用量减少。IBRSB组术中血流动力学更稳定。术后6个时间点,两组间休息和运动时疼痛评分相似。无阻滞相关并发症发生。结论:与双侧RSB相比,基于切口位置和创伤严重程度的IBRSB可显著降低LACS患者术中和术后阿片类药物需求,改善血流动力学稳定性,且未增加并发症。关于该主题的已知信息:腹腔镜手术需要小的中线切口和多个套管针,导致分散的伤口。基于切口的精确多点直肌鞘阻滞(RSB),适合手术部位,通过局部浸润和神经阻断双重镇痛,可能比双侧RSB更适合腹腔镜辅助结直肠手术。本研究补充的内容:主要发现是超声引导的基于切口的精确多点RSB,与双侧RSB相比,显著减少了腹腔镜辅助结直肠手术患者术中和术后吗啡当量。本研究对研究、实践或政策的影响:基于切口的精确多点技术是一种安全有效的技术,推荐用于腹腔镜辅助结直肠手术患者的常规实施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Postgraduate Medical Journal
Postgraduate Medical Journal 医学-医学:内科
CiteScore
8.50
自引率
2.00%
发文量
131
审稿时长
2.5 months
期刊介绍: Postgraduate Medical Journal is a peer reviewed journal published on behalf of the Fellowship of Postgraduate Medicine. The journal aims to support junior doctors and their teachers and contribute to the continuing professional development of all doctors by publishing papers on a wide range of topics relevant to the practicing clinician and teacher. Papers published in PMJ include those that focus on core competencies; that describe current practice and new developments in all branches of medicine; that describe relevance and impact of translational research on clinical practice; that provide background relevant to examinations; and papers on medical education and medical education research. PMJ supports CPD by providing the opportunity for doctors to publish many types of articles including original clinical research; reviews; quality improvement reports; editorials, and correspondence on clinical matters.
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