Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study
Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study
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DOI：
10.3390/jcm8071018
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发表时间：
2019-07-01
影响因子：
3.9
通讯作者：
Lee, Jong-Hyuk
中科院分区：
文献类型：
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作者：
Jeong, Hye-Won;Kim, Chan Sik;Lee, Jong-Hyuk
背景：腹腔镜胆囊切除术（LC）后的疼痛是多因素的，通常无法有效治疗。已证明直肠鞘块（RSB）可减轻中线切口和腹腔镜手术的疼痛。我们研究了LC后RSB的先发性镇痛作用。方法：在这项前瞻性，随机，单中心试验中，有200例接受LC的患者被随机分为术前RSB（PERE-RSB）或术后RSB（后RSB）组。在RSB组的皮肤切口前或在RSB后组的皮肤闭合之前，在皮肤切口前进行了超声引导的RSB。主要结果是在手术后24小时内总救援镇痛药消耗。次要结局是通过数值评分量表（NRS）在术后累积的救援镇痛量和术后疼痛进行的，手术后手术后进行了累积的镇痛量和术后疼痛。结果：在术前24小时，RSB组的救援镇痛药的总救援量明显低于RSB后组（p = 0.020）。前RSB组的累积救援镇痛消耗明显低于1小时后RSB组（p = 0.023），9小时（p = 0.020）和18 h（p = 0.002）手术后的RSB组。在术前0小时，在RSB组中，NRS显着低于后RSB组（p = 0.023）。结论：与后RSB相比，RSB的前RSB减少了接受LC患者的镇痛需求。
Background: Pain after laparoscopic cholecystectomy (LC) is multifactorial and usually not effectively treated. Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision and laparoscopic surgery. We investigated the preemptive analgesic effect of RSB after LC. Methods: In this prospective, randomized, single-center trial, 200 patients undergoing LC were randomized into preoperative RSB (pre-RSB) or postoperative RSB (post-RSB) group. An ultrasound-guided RSB was performed before skin incision in the pre-RSB group or after skin closure in the post-RSB group. The primary outcome was total rescue analgesic consumption at 24 h post-surgery. The secondary outcomes were cumulated rescue analgesic consumption and postoperative pain measured by numerical rating scale (NRS) at 0, 1, 2, 6, 9, 18, and 24 h post-surgery. Results: Total rescue analgesic consumption at 24 h post-surgery was significantly lower in the pre-RSB group than in the post-RSB group (p = 0.020). The cumulated rescue analgesic consumption was significantly lower in the pre-RSB group than in the post-RSB group at 1 h (p = 0.023), 9 h (p = 0.020) and 18 h (p = 0.002) post-surgery. NRS was significantly lower in the pre-RSB group than in the post-RSB group at 0 h post-surgery (p = 0.023). Conclusion: The pre-RSB reduced the analgesic requirements in patients undergoing LC compared with the post-RSB.