دانلود رایگان مقاله انگلیسی کاهش درد زودهنگام پس از عمل جراحی لاپروسکوپی توسط بلوک رکتوس دو طرفه با سونوگرافی - اشپرینگر 2018

Abstract

Purpose Rectus sheath block (RSB) is an anterior abdominal wall block that reduces postoperative pain associated with midline incisions. This study aims to investigate the efect of ultrasound-guided bilateral RSB (US-BRSB) on postoperative pain and analgesic consumption in patients undergoing laparoscopic gynecologic surgery. Methods Sixty patients who underwent laparoscopic gynecologic surgery were allocated to RSB (n = 30) or control (n = 30) group. A bilateral US-BRSB procedure (30 ml of 0.25% ropivacaine) was performed after induction of general anesthesia in the RSB group. The control group proceeded the surgery without sham block. All patients received fentanyl-based intravenous patient-controlled analgesia and rescue analgesics upon demand. Pain was scored by a blinded observer using a verbal numerical rating scale (VNRS) at rest while coughing at 0, 1, 6, 12, 24, and 48 h after postanesthesia care unit (PACU) admission. The primary outcome was the total number of rescue analgesics used in the 48-h postoperative period. Results At 0 h, VNRS were lower in the RSB group than in the control, both at rest (median VNRS 4.5 vs. 5, p = 0.02) and while coughing (median VNRS 6 vs. 7, p = 0.004). At 6 h, VNRS scores were lower in the RSB group than in the control while coughing (median VNRS 3 vs. 5, p = 0.01). Fentanyl use as rescue analgesics in the PACU was signifcantly lower in the RSB group than in the control (27.7 ± 32.1 vs. 53.3 ± 33.7 µg, respectively; p = 0.004). At 48 h postoperatively, the total number of rescue analgesics administered were signifcantly fewer in the RSB group than in the control (2.5 ± 2.5 vs. 3.9 ± 2.6, respectively; p = 0.04). Conclusion US-BRSB reduces the immediate postoperative pain and opioid consumption during the early postoperative period.

Discussion

This study described the efects of US-BRSB on early postoperative pain after multi-port laparoscopic gynecologic surgery. Upon arrival at the PACU, pain intensity in the RSB group was lower compared to the control group. VNRSc scores at 6 h postoperatively were also lower in the RSB group. Opioid consumption in the PACU at 1 h was signifcantly lower in the RSB group and more patients of the RSB group did not request rescue analgesics in PACU.

However, no diference was observed between groups in terms of the IV-PCA data, while the cumulative number of rescue analgesics was signifcantly lower in the RSB group at all timepoints. Pain management during the immediate postoperative period is critical, because inadequate pain control is associated with pulmonary or cardiac complications and increased morbidity and mortality [14]. Furthermore, the severity of postoperative pain afects postoperative quality-of-life and enhanced recovery [15–18]. Emotional state in the perioperative period is related to the degree of persistent pain after surgery [19]; this demonstrates the importance of careful management of postoperative pain.