TAP阻滞与硬膜外镇痛在机器人辅助前列腺根治术术后镇痛效果的比较

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
O. Volkov, Lutsenko V.V., M.O. Plis, M.V. Pavlenko, Krishtafor D.A.
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引用次数: 0

摘要

疼痛仍然是根治性前列腺切除术后的一个重要问题,导致不适,有时延长住院时间。尽管腹腔镜手术是侵入性较小的手术干预,但在术后疼痛方面仍然具有挑战性,因为涉及到躯体和内脏疼痛途径。为了减轻腹腔镜前列腺切除术后的疼痛并优化恢复,区域麻醉技术已被用于避免或减少对阿片类药物的需求。我们研究的目的是调查腹腔镜机器人辅助根治性前列腺切除术后患者的术后恢复情况,这取决于术后镇痛方法和机器人手术麻醉的特殊性。为了实现这一目标,“医疗广场”医疗中心使用机器人系统对49名接受根治性前列腺切除术的患者进行了检查。患者分为两组。第一组(n=25):术中麻醉加硬膜外0.125%布比卡因联合镇痛。2组24例患者在最后一次缝合后立即在腹部两侧皮肤上用0.25%布比卡因15 ml进行tap阻滞。根据美国麻醉医师学会(ASA)评分标准,两组患者年龄、身高、体重、生理状态差异无统计学意义(p >0.05)。分析统计资料发现,各研究组前列腺体积、手术时间、出血量均无差异(p >0.05)。两组之间的血压和心率波动相似。两组间肌肉松弛剂用量比较,差异无统计学意义(p >0.05)。麻醉时阿片类药物用量无显著性差异(p < 0.05)。两组患者在8小时内活动,差异无统计学意义(p=0.094)。在活动时,镇痛方法与一侧下肢无力之间存在直接的中等强度显著相关(r=0.69;P =0.039),前列腺大小与气管拔管时间之间存在直接的中等强度显著相关(r=0.39;p = 0.041)。因此,术中出血量与围术期镇痛的变化无关。术中加入硬膜外镇痛后,血流动力学和心率没有下降。术中以低浓度局麻开始硬膜外镇痛不影响术后活动率。机器人根治性前列腺切除术后的疼痛是中度的,但需要多模式治疗,以便患者更快地活动,适应现有的导尿管。硬膜外镇痛和TAP阻滞在术后疼痛管理中都显示出足够的安全性和有效性。根治性前列腺切除术后,tap阻断是一种有效的镇痛方法,同时不影响患者及时充分活动。硬膜外镇痛具有很高的镇痛效果,但存在一定的导管移位和干扰患者充分活动的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of TAP block and epidural analgesia for postoperative analgesia after robotic-assisted radical prostatectomy
Pain remains an important problem after radical prostatectomy, leading to discomfort and sometimes prolonged hospital stays. Despite the fact that laparoscopic procedures are less invasive surgical interventions, they can still be challenging in terms of postoperative pain, as both somatic and visceral pain pathways are involved. To alleviate pain and optimize improved recovery after laparoscopic prostatectomy, regional anesthesia techniques have been used to avoid or reduce the need for opioids. The aim of our study was to investigate the postoperative recovery of patients after laparoscopic robotic-assisted radical prostatectomy, depending on the method of postoperative analgesia and in the context of the peculiarities of anesthesia in robotic surgery. To achieve this goal, the “Medical Plaza” Medical Center examined 49 patients who underwent radical prostatectomy using a robotic system. Patients were divided into 2 groups. Group 1 (n=25) – combined intraoperative anesthesia with epidural analgesia with 0.125% bupivacaine. Patients in group 2 (n=24) underwent TAP-block with 15 ml of 0.25% bupivacaine immediately after the last suture was placed on the skin both sides of the abdomen. Patients in the groups did not differ in age, height, body weight and physiological status (р>0.05) according to the American Society of Anesthesiologists (ASA) scale. When analyzing the statistical data it was found that the volume of the prostate did not differ in the study groups, as well as the duration of the operation and the amount of blood loss (р>0.05). Blood pressure and heart rate fluctuations were similar between the groups. The amount of muscle relaxants used had no statistical difference in the study groups (р>0.05). The amount of opiates used during anesthesia did not differ (р>0.05). Mobilization of patients in both groups occurred in 8 hours without statistical difference (p=0.094). A direct medium strength significant correlation was found between the method of analgesia and weakness in one of the lower limbs at the time of mobilization (r=0.69; p=0.039), a direct medium strength significant correlation was found between the size of the prostate and the time to tracheal extubation (r=0.39; p=0.041). So, the level of intraoperative blood loss did not depend on the variants of perioperative analgesia. Haemodynamics and heart rate did not decrease with the addition of intraoperative epidural analgesia. Intraoperative initiation of epidural analgesia with a low concentration of local anesthetic does not affect the rate of postoperative mobilization. Pain after robotic radical prostatectomy is moderate, but requires multimodal treatment for faster mobilization of the patient, adaptation to the existing urinary catheter. Both epidural analgesia and TAP block have shown sufficient safety profile and efficacy in postoperative pain management. After radical prostatectomy, the TAP-block is an effective method of analgesia, while not interfering with the timely full mobilization of the patient. Epidural analgesia has a high analgesic profile, but is associated with certain risks of catheter migration and interference with full mobilization of the patient.
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来源期刊
Medical Perspectives-Medicni Perspektivi
Medical Perspectives-Medicni Perspektivi MEDICINE, GENERAL & INTERNAL-
CiteScore
0.40
自引率
0.00%
发文量
85
审稿时长
9 weeks
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