在单端口 laparoscopic 附带外科手术中用于术后止痛的Quadratus Lumborum 块和直肠块的比较:一项随机对照试验
Dongju Kim1, Seunguk Bang2, Jihyun Chung2
1Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea.
Medicina (Kaunas, Lithuania)
|June 27, 2025
概括
在单端口腹腔镜附带手术后,直肠块 (RSB) 显著降低了阿片类药物消耗,相比于单端口腹腔膜块 (QLB),提供了改善的疼痛管理,具有类似的疗效.
科学领域:
- 麻醉学 麻醉学
- 区域麻醉地区麻醉
- 疼痛管理 疼痛管理
背景情况:
- 区域麻醉对于微创妇科手术中的多模式止痛至关重要.
- 单端口腹腔镜附带外科手术提出了独特的解剖学和生理学挑战,影响了疼痛.
- 对于这种方法的程序特定的区域止痛方案的证据有限.
研究的目的:
- 为了比较四角腰部块 (QLB) 和直肠块 (RSB) 的止痛效果.
- 为了评估阿片类药物消耗,疼痛评分,以及单端口腹腔镜附带手术后的术后恶心和吐 (PONV).
主要方法:
- 随机对照试验涉及64名接受单端口腹腔镜附带手术的患者.
- 患者在术后接受了QLB或RSB.
- 主要结局:在前24小时内累积的阿片类药物消费;次要结局:疼痛得分,第一次患者控制止痛 (PCA) 囊的时间,PONV.
主要成果:
- 该RSB组显示24小时累积阿片类药物消费显著降低 (132.9μg与453.0μg相比,p<0.001).
- 此外,RSB还导致首次PCA胆固醇治疗的时间显著延长 (56.5分钟与40.5分钟相比,p = 0.014).
- 疼痛评分和PONV发病率在QLB和RSB组之间是可比的.
结论:
- 在单端口腹腔镜附带手术后,直肠块 (RSB) 提供了优越的阿片类药物节约止痛效果,相比于单端口腹腔镜附带手术后的四角腹腔块 (QLB).
- RSB提供了与QLB相比的疼痛缓解,减少了阿片类药物需求.
- 这些发现支持为这种手术方法开发基于RSB的,程序特定的止痛方案.
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