在机器人前列腺切除术中使用无阿片类药物麻醉:在没有横向腹部平面阻断的情况下进行疼痛管理
Ana Tejedor1, Marta García2, Pere Serra2
1Department of Anesthesiology, Sant Joan Despí Moisès Broggi Hospital, Barcelona, Spain - atejedorn@csi.cat.
Minerva anestesiologica
|December 2, 2025
概括
横腹平面 (TAP) 阻断在无阿片类药物麻醉 (OFA) 机器人辅助腹腔镜激进前列腺切除术 (RALP) 中的疼痛管理中并不重要. 这项研究发现,接受TAP阻断剂和未接受TAP阻断剂的患者之间的阿片类药物使用或疼痛评分没有显著差异.
科学领域:
- 麻醉学 麻醉学
- 手术疼痛管理手术疼痛管理
- 在瘤学瘤学.
背景情况:
- 横腹平面 (TAP) 阻断是一种用于机器人辅助腹腔镜激进前列腺切除术 (RALP) 的标准止痛方法.
- 在无阿片类麻醉 (OFA) 策略中,TAP阻断的必要性需要进行调查.
- 这项研究评估了TAP阻断在RALP的OFA期间优化疼痛控制中的作用.
研究的目的:
- 为了确定TAP阻断是否对于通过OFA策略进行RALP的患者的有效疼痛管理至关重要.
- 为了比较患有TAP阻断和没有TAP阻断的患者之间的术后阿片类药物需求和疼痛评分.
主要方法:
- 一项追溯的准实验性研究,涉及40名接受RALP的成年患者.
- 所有患者都接受了OFA策略,持续静脉注射利多卡因,德克斯米德托米丁和胺.
- 在TAP阻断组和非TAP阻断组之间比较外科手术期间的阿片类药物需求 (IV MME),疼痛评分 (NRS) 和其他临床结果.
主要成果:
- 周术期阿片类药物需求在两组中都是最小的和相似的 (中位数为0 IV MME).
- 在两组所有术后时间点中,数值评分表 (NRS) 疼痛评分仍然很低 (中位数≤1).
- 多变量分析显示TAP阻断和减少阿片类药物消费之间没有独立的关联;没有观察到恢复或并发症的显著差异.
结论:
- 在这项单中心研究中,外皮质RALP,TAP阻断在与OFA策略相结合时没有提供额外的止痛益处.
- 这些发现表明,TAP阻断可能不是OFA下的RALP多模式止痛的必要组成部分.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
888
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
888
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
1.1K
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
1.1K
Parenteral Anesthetics: Overview
546
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
546
Analgesia and Pain Management
1.4K
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
1.4K
Local Anesthetics: Clinical Application as Epidural Anesthesia
672
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
672
Local Anesthetics: Clinical Application as Spinal Anesthesia
1.3K
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
1.3K


