腹直肌鞘阻滞用于开放性胃切除术中的镇痛效果：一项前瞻性双盲随机对照临床试验
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Analgesic effectiveness of rectus sheath block during open gastrectomy: A prospective double-blinded randomized controlled clinical trial
背景与目的
近年来尽管胃癌手术已取得显著进展，但开放性胃切除术仍然是治疗胃癌的常用方法。 由于腹部切口大，导致手术中所需阿片量增加、术后疼痛加剧。众所周知，术后疼痛对患者的免疫系统有负面影响。在此，本研究旨在对全麻下行开放式胃切除术患者进行超声引导下双侧腹直肌鞘阻滞（RSB），并分析RSB在开放式胃切除术中的镇痛效果。
方 法
将46例计划行开放性胃切除术患者随机分为2组：A组（n=21）由超声引导下使用40 ml 0.375%罗哌卡因进行RSB治疗的患者组成；B组（n=20）由使用40 ml生理盐水进行RSB治疗的患者组成。每名患者在皮肤闭合后立即连接电子注射泵进行自控镇痛（PCA）。记录术中瑞芬太尼用量和使用PCA后每位患者PCA消耗量，并用Excel进行分析。
结 果
A组瑞芬太尼用量(1021.4 ± 172.0 μg)明显少于B组(1415.0 ± 330.6 μg；p = 0.03)。直至术后2h，PCA消耗剂量A组(1 h：1.14 ± 0.9，2 h：0.85 ± 0.7)明显低于B组(1 h：1.85 ± 0.7，2 h：1.45 ± 1.0） (1 h，p = 0.008)；2 h，p = 0.03)，但术后3 h，两组PCA消耗剂量无显著性差异(P>0.0 5)。
结 论
如果40 ml 0.35%罗哌卡因的超声引导双侧RSB在接受开放式胃切除术患者中精确地进行，手术期间对瑞芬太尼需求降低。不仅如此，还可显著降低术后2小时内用于急性术后疼痛PCA剂量。
原始文献摘要
Hong Seongwook, Kim Hyunjeong, Park Junmo, Analgesic effectiveness of rectus sheath block during open gastrectomy: A prospective double-blinded randomized controlled clinical trial[J]. Medicine (Baltimore), 2019, 98: e15159.
BACKGROUND:Despite recent advances in gastric cancer surgery, open gastrectomy is often needed to treat gastric cancer. Due to the large incision in the abdomen, the amount of opioid required during surgery increases and postoperative pain becomes worse. It is well known that postoperative pain has a negative impact on the patient's immune system. Herein, we performed an ultrasound-guided bilateral rectus sheath block (RSB) in patients undergoing open gastrectomy under general anesthesia and analyzed the analgesic effectiveness of RSB in open gastrectomy.
METHODS:A total of 46 patients scheduled for open gastrectomy were randomly divided into 2 groups: Group A (n = 21) consisted of patients who received an RSB using 40 mL of 0.375% ropivacaine under ultrasound guidance and Group B (n = 20) consisted of patients who received an RSB using 40 mL of normal saline. An electronic injection pump was connected to each patient for patient-controlled analgesia (PCA) immediately after the skin closure. The amount of remifentanil required during the surgery was analyzed. After using PCA, data on the use of PCA bolus dose were extracted and analyzed using Excel.
RESULTS:Group A used significantly less remifentanil (1021.4 ± 172.0 μg) than group B (1415.0 ± 330.6 μg; P = .03). The number of PCA bolus dose provided to the patients after surgery was significantly lower in group A (1 h: 1.14 ± 0.9, 2 h: 0.85 ± 0.7) than in group B (1 h: 1.85 ± 0.7, 2 h: 1.45 ± 1.0) until 2 hours after the surgery (1 h, P = .008; 2 h, P = .03), but after 3 hours, there were no significant differences between the 2 groups.
CONCLUSIONS:If ultrasound-guided bilateral RSB with 40 mL of 0.35% ropivacaine is performed precisely in patients undergoing open gastrectomy, the requirement for remifentanil during surgery can be reduced. In addition, it significantly reduces the use of PCA bolus dose for acute postoperative pain within 2 hours after surgery.
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贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：余晓旭 审校：王贵龙