{"title":"以平卧位结合 Trendelenburg 体位进行腹腔镜手术和机器人辅助手术后的下肢疼痛和/或麻木。","authors":"Keiko Yamasaki, Keisuke Fujii, Yasuo Kohjimoto, Kenji Matsuda, Hiromitsu Iwamoto, Manabu Kawai, Ke Wan, Tomoyuki Kawamata","doi":"10.1007/s00540-024-03399-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate the incidence and risk factors of lower extremity pain and/or numbness after laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position. The relationship between creatine kinase (CK) levels and lower extremity pain and/or numbness was also investigated.</p><p><strong>Methods: </strong>We retrospectively reviewed adult patients who underwent laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position between May 2015 and April 2020. Logistic regression analysis was used to identify risk factors of lower extremity pain and/or numbness. Preoperative and postoperative CK levels were compared in patients with and those without lower extremity pain and/or numbness.</p><p><strong>Results: </strong>Among 940 patients, 1.9% experienced lower extremity pain and/or numbness postoperatively. The incidences of lower extremity pain and/or numbness after laparoscopic colorectal surgery and after robot-assisted laparoscopic radical prostatectomy were 1.7% and 2.1%, respectively. Multivariate logistic regression analysis revealed that only duration of surgery > 4 h (odds ratio = 3.144, 95% CI: 1.102-8.969, p = 0.032) was a significant predictor of lower extremity pain and/or numbness. Postoperative median CK level in patients with lower extremity pain and/or numbness was significantly higher than that in patients without lower extremity pain and/or numbness.</p><p><strong>Conclusion: </strong>The incidence of lower extremity pain and/or numbness after laparoscopic colorectal surgery was comparable to that after robot-assisted laparoscopic radical prostatectomy. Prolonged duration of surgery contributed to lower extremity pain and/or numbness. Significantly elevated CK levels in patients with lower extremity pain and/or numbness suggest the involvement of muscle injury in these symptoms.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lower extremity pain and/or numbness after laparoscopic surgery and robot-assisted surgery in the lithotomy position combined with the Trendelenburg position.\",\"authors\":\"Keiko Yamasaki, Keisuke Fujii, Yasuo Kohjimoto, Kenji Matsuda, Hiromitsu Iwamoto, Manabu Kawai, Ke Wan, Tomoyuki Kawamata\",\"doi\":\"10.1007/s00540-024-03399-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The purpose of this study was to investigate the incidence and risk factors of lower extremity pain and/or numbness after laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position. The relationship between creatine kinase (CK) levels and lower extremity pain and/or numbness was also investigated.</p><p><strong>Methods: </strong>We retrospectively reviewed adult patients who underwent laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position between May 2015 and April 2020. Logistic regression analysis was used to identify risk factors of lower extremity pain and/or numbness. Preoperative and postoperative CK levels were compared in patients with and those without lower extremity pain and/or numbness.</p><p><strong>Results: </strong>Among 940 patients, 1.9% experienced lower extremity pain and/or numbness postoperatively. The incidences of lower extremity pain and/or numbness after laparoscopic colorectal surgery and after robot-assisted laparoscopic radical prostatectomy were 1.7% and 2.1%, respectively. Multivariate logistic regression analysis revealed that only duration of surgery > 4 h (odds ratio = 3.144, 95% CI: 1.102-8.969, p = 0.032) was a significant predictor of lower extremity pain and/or numbness. Postoperative median CK level in patients with lower extremity pain and/or numbness was significantly higher than that in patients without lower extremity pain and/or numbness.</p><p><strong>Conclusion: </strong>The incidence of lower extremity pain and/or numbness after laparoscopic colorectal surgery was comparable to that after robot-assisted laparoscopic radical prostatectomy. Prolonged duration of surgery contributed to lower extremity pain and/or numbness. Significantly elevated CK levels in patients with lower extremity pain and/or numbness suggest the involvement of muscle injury in these symptoms.</p>\",\"PeriodicalId\":14997,\"journal\":{\"name\":\"Journal of Anesthesia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00540-024-03399-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00540-024-03399-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究旨在调查在平卧位结合 Trendelenburg 体位下进行腹腔镜结直肠手术和机器人辅助腹腔镜根治性前列腺切除术后下肢疼痛和/或麻木的发生率和风险因素。我们还研究了肌酸激酶（CK）水平与下肢疼痛和/或麻木之间的关系：我们回顾性研究了2015年5月至2020年4月期间接受腹腔镜结直肠手术和机器人辅助腹腔镜根治性前列腺切除术的成年患者，这些患者均采用了平卧位结合特伦德兰堡体位。采用逻辑回归分析确定下肢疼痛和/或麻木的风险因素。比较了下肢疼痛和/或麻木患者与无下肢疼痛和/或麻木患者术前和术后的 CK 水平：结果：在940名患者中，1.9%的患者术后出现下肢疼痛和/或麻木。腹腔镜结直肠手术和机器人辅助腹腔镜前列腺癌根治术后下肢疼痛和/或麻木的发生率分别为1.7%和2.1%。多变量逻辑回归分析显示，只有手术时间大于 4 小时（几率比=3.144，95% CI：1.102-8.969，p=0.032）才是下肢疼痛和/或麻木的重要预测因素。下肢疼痛和/或麻木患者的术后中位 CK 水平明显高于无下肢疼痛和/或麻木患者：结论：腹腔镜结直肠手术后下肢疼痛和/或麻木的发生率与机器人辅助腹腔镜前列腺癌根治术后的发生率相当。手术时间过长是导致下肢疼痛和/或麻木的原因之一。下肢疼痛和/或麻木患者体内的肌酸激酶水平显著升高，表明这些症状与肌肉损伤有关。
Lower extremity pain and/or numbness after laparoscopic surgery and robot-assisted surgery in the lithotomy position combined with the Trendelenburg position.
Purpose: The purpose of this study was to investigate the incidence and risk factors of lower extremity pain and/or numbness after laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position. The relationship between creatine kinase (CK) levels and lower extremity pain and/or numbness was also investigated.
Methods: We retrospectively reviewed adult patients who underwent laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position between May 2015 and April 2020. Logistic regression analysis was used to identify risk factors of lower extremity pain and/or numbness. Preoperative and postoperative CK levels were compared in patients with and those without lower extremity pain and/or numbness.
Results: Among 940 patients, 1.9% experienced lower extremity pain and/or numbness postoperatively. The incidences of lower extremity pain and/or numbness after laparoscopic colorectal surgery and after robot-assisted laparoscopic radical prostatectomy were 1.7% and 2.1%, respectively. Multivariate logistic regression analysis revealed that only duration of surgery > 4 h (odds ratio = 3.144, 95% CI: 1.102-8.969, p = 0.032) was a significant predictor of lower extremity pain and/or numbness. Postoperative median CK level in patients with lower extremity pain and/or numbness was significantly higher than that in patients without lower extremity pain and/or numbness.
Conclusion: The incidence of lower extremity pain and/or numbness after laparoscopic colorectal surgery was comparable to that after robot-assisted laparoscopic radical prostatectomy. Prolonged duration of surgery contributed to lower extremity pain and/or numbness. Significantly elevated CK levels in patients with lower extremity pain and/or numbness suggest the involvement of muscle injury in these symptoms.
期刊介绍：
The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite.
The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.
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