在全身麻醉下进行跨腺前列腺活检后进行皮下局部麻醉:一项随机试验
Abdullah Al-Khanaty1,2, Shannon McGrath1, Eoin Dinneen2,3
1Department of Surgery and Department of Urology, Austin Health, The University of Melbourne, Melbourne, VIC, Australia.
BJU international
|January 8, 2026
概括
皮下局部麻醉 (LA) 透有效地降低了在全身麻醉 (GA) 下跨 (TP) 前列腺活检后的直接术后疼痛. 这种简单,安全的干预措施有利于大量患者,特别是那些接受广泛活检的患者.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
背景情况:
- 跨关节 (TP) 前列腺活检是诊断前列腺癌的常见程序.
- 在TP前列腺活检后的疼痛管理,特别是在全身麻醉 (GA) 下,仍然是优化领域.
- 目前的止痛策略可能无法完全解决手术后立即的不适.
研究的目的:
- 评估皮下局部麻醉 (LA) 入围刺部位的有效性,以减少手术后立即的疼痛.
- 评估GA-TP活检后LA对患者报告的疼痛评分和阿片类药物需求的影响.
主要方法:
- 进行了一项双中心,患者失明,随机,安慰剂控制的试验.
- 接受GA-TP活检的男性接受了20毫升0.5%的布皮瓦卡因或通过皮下透的正常盐溶液.
- 主要终点:手术后30分钟中度至重度疼痛 (VAS>3) 的患者比例.
主要成果:
- 8.7%的接受LA治疗的患者报告中度至重度疼痛,而对照组为22.5% (绝对风险降低13.8%,P=0.035).
- 视觉模拟量表 (VAS) 和短形式麦吉尔疼痛问卷 (SF-MPQ) 的中位数得分在两组中都很低 (0).
- 在接受>20核活检 (34.1%对10.6%) 的患者中,LA的益处更为明显.
结论:
- 皮下LA透显著降低了GA-TP前列腺活检后的直接中度至重度疼痛.
- 这种简单,低成本和安全的方法为一小部分患者提供了临床上有意义的疼痛缓解.
- 研究结果支持在TP活检程序中使用表面LA透作为现有止痛方案的辅助.
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