对比双边直肠外套阻塞和胸部外周止痛治疗术后疼痛控制在开放性胃切除术后:一个随机对照试验
Janis Opincans1,2, Igors Ivanovs1,2, Aleksejs Miscuks2
1Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia.
Medicina (Kaunas, Lithuania)
|September 27, 2025
概括
双边直肠围阻断 (RSB) 提供优越的疼痛控制和开放胃切除术后更快的恢复,与胸部外围止痛疗法 (TEA) 相比. RSB显著减少疼痛,阿片类药物使用和住院,增强患者的康复.
科学领域:
- 麻醉学 麻醉学
- 手术疼痛管理手术疼痛管理
- 区域麻醉地区麻醉
背景情况:
- 胸腔外周止痛疗法 (TEA) 是主要腹部手术疼痛的标准.
- 双边直肠块 (RSB) 是一种可行的替代区域技术.
- 优化术后疼痛管理对于胃切除术后患者康复至关重要.
研究的目的:
- 为了比较RSB与TEA在早期术后疼痛控制方面的疗效.
- 评估RSB和TEA对开放胃切除术后恢复的影响.
- 在接受胃切除术的患者中评估阿片类药物消耗和疼痛强度.
主要方法:
- 随机对照试验涉及70名接受开放性胃切除术的患者.
- 组A通过RSB连续输注布皮瓦卡因.
- 组B接受了TEA与布皮瓦卡因和芬太尼.
- 主要结局:手术后的阿片类药物消费和视觉模拟尺度 (VAS) 疼痛评分.
主要成果:
- 在手术后24小时和48小时,RSB组的VAS得分显著降低.
- 在RSB组中,需要救援止痛的患者较少 (17%与TEA组在48小时后的94%相比).
- RSB导致了更短的住院时间 (6 vs 9 天) 和更早的肠道功能恢复.
结论:
- 双边直肠膜阻塞是TEA开放胃切除术的安全有效替代方案.
- RSB显著改善了疼痛管理,减少了药物需求,并加速了恢复.
- 通过RSB连续输注布皮瓦卡因可促进早期康复,并缩短胃切除术后住院时间.
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