腹腔镜结直肠癌根治术中深度神经肌肉阻滞联合低气腹压麻醉策略对术后疼痛的影响

The effect of deep neuromuscular block combined with low pneumoperitoneum pressure on postoperative pain in patients undergoing laparoscopic radical colorectal surgery

目的探讨深度神经肌肉阻滞(DNMB)联合低气腹压麻醉策略对腹腔镜结直肠癌根治术患者术后疼痛的影响。方法本研究为随机对照试验,选取2022年12月1日至2023年5月31日中国医学科学院肿瘤医院接受腹腔镜结直肠癌根治手术患者120例,随机数字表法分为两组:对照组(C组,n=60):术中维持中度神经肌肉阻滞[四个成串刺激计数(TOFC)=1~2],气腹压维持在15 mmHg(1 mmHg=0.133 kPa);DNMB联合低气腹压组(D组,n=60):术中维持DNMB[强直刺激后计数(PTC)=1~2],气腹压维持在10 mmHg。主要研究指标为术后1 h中重度疼痛发生率。次要研究指标包括:术后1、2、3、5 d和3个月中重度疼痛发生率,挽救性镇痛药物使用率,镇痛泵舒芬太尼使用量,外科评分量表(SRS)评分,术后肌松残余发生率,术后恢复情况[包括麻醉恢复室(PACU)停留时间、术后首次排气排便时间和住院时间]以及术后炎症反应情况[术后1、3 d外周血白细胞介素(IL)-1β和IL-6浓度]。结果D组患者术后1 h中重度疼痛发生率为13.3%(8/60),低于C组的30.0%(18/60)(P<0.05)。D组患者术后1 h和1 d挽救性镇痛药物使用率分别为13.3%(8/60)和4.2%(5/120),低于C组的30.0%(18/60)和12.5%(15/120)(均P<0.05)。D组患者术后1 d的IL-1β水平为(4.1±1.8)ng/L,低于C组的(4.9±2.6)ng/L(P=0.048);术后3 d的IL-6水平为(2.0±0.7)ng/L,低于C组的(2.4±1.1)ng/L(P=0.018)。两组患者镇痛泵舒芬太尼使用量、术中SRS评分、肌松残余发生率、PACU停留时间、术后首次排气排便时间和住院时间差异均无统计学意义(均P>0.05)。结论DNMB联合低气腹压麻醉策略可减轻腹腔镜结直肠癌根治术患者术后早期疼痛发生率。

Objective To investigate the effect of deep neuromuscular blockade(DNMB)combined with low pneumoperitoneum pressure anesthesia strategy on postoperative pain in patients undergoing laparoscopic colorectal surgery.Methods This study was a randomized controlled trial.One hundred and twenty patients who underwent laparoscopic colorectal surgery at Cancer Hospital of Chinese Academy of Medical Sciences from December 1,2022 to May 31,2023 were selected and randomly divided into two groups by random number table method.Moderate neuromuscular blockade[train of four stimulations count(TOFC)=1-2]was maintained in patients of the control group(group C,n=60)and pneumoperitoneum pressure level was set at 15 mmHg(1 mmHg=0.133 kPa).DNMB[post-tonic stimulation count(PTC)=1-2]was maintained in patients of the DNMB combined with low pneumoperitoneum pressuregroup(group D,n=60)and pneumoperitoneum pressure level was set at 10 mmHg.The primary measurement was incidence of moderate to severe pain at 1 h after surgery.The secondary measurements the included incidence of moderate to severe pain at 1,2,3,5 d and 3 months after surgery,the incidence of rescue analgesic drug use,the doses of sufentanil in analgesic pumps,surgical rating scale(SRS)score,the incidence of postoperative residual neuromuscular block,postoperative recovery[evaluated with length of post anesthesia care unit(PACU)stay,time of first exhaust and defecation after surgery and length of hospital stay]and postoperative inflammation conditions[evaluated with serum concentration of interleukin(IL)-1βand IL-6 at 1 d and 3 d after surgery].Results The incidence of moderate to severe pain in group D 1 h after surgery was 13.3%(8/60),lower than 30.0%(18/60)of group C(P<0.05).The incidence of rescue analgesia in group D at 1 h and 1 d after surgery were 13.3%(8/60)and 4.2%(5/120),respectively,lower than 30.0%(18/60)and 12.5%(15/120)of group C(both P<0.05).The IL-1βlevel in group D was(4.1±1.8)ng/L at 1 d after surgery,which was lower than(4.9±2.6)ng/L of group C(P=0.048).The IL-6 level in group D was(2.0±0.7)ng/L at 3 d after surgery,which was lower than(2.4±1.1)ng/L of group C(P=0.018).There was no significant difference in the doses of sufentanil in analgesic pumps,intraoperative SRS score,incidence of neuromuscular block residue,time spent in PACU,time of first exhaust and defecation after surgery,incidence of nausea and vomiting,and length of hospitalization between the two groups(all P>0.05).Conclusion DNMB combined with low pneumoperitoneum pressure anesthesia strategy alleviates the early-stage pain in patients after laparoscopic colorectal surgery.