神经刺激仪引导下阴部神经阻滞在痔术后镇痛效果研究

Study on the analgesic effect of nerve stimulator guided pudendal nerve block after hemorrhoidectomy

目的探讨神经刺激仪引导下阴部神经阻滞在痔术后镇痛的运用,并与传统伤口局部浸润麻醉作术后镇痛效果及安全性的比较。方法选取2016年4月-2018年12月本院肛肠外科收治的混合痔患者,行Milligan-Morgan手术患者共100例作为研究对象,按随机对照原则分为神经刺激仪引导下阴部神经阻滞组(实验组A)和伤口局部浸润麻醉组(实验组B)两组。观察比较两组术后视觉模拟评分,救援性镇痛曲马多使用率、尿潴留发生率,门诊随访统计各组并发症发生情况。结果实验组A在术后12 h、24 h、48 h的疼痛评分明显低于实验组B,差异具有统计学意义(P<0.05);两组在术后第1次排便、术后第2次排便疼痛评分无统计学差异(P>0.05)。两组术后尿潴留发生率、救援性镇痛曲马多使用率、术后并发症无明显统计学差异。结论神经神经刺激仪引导下阴部神经主干阻滞镇痛效果明显优于伤口局部浸润麻醉,镇痛效果确切,且安全可靠,在肛肠手术镇痛领域可广泛使用。

Objective To explore the application of nerve stimulator guided pudendal nerve block after hemorrhoidectomy,and the effect and safety were compared with the traditional wound local infiltration anesthesia.Methods 100 cases of patients with mixed hemorrhoid,those who were treated by Milligan-Morgan operations in our institute form April 2016 to December 2018,were randomized into group A(bilateral pudendal nerve block with nerve stimulator) and group B(wound local anesthesia).Evaluated parameters were scored by visual analogue scale,demanding extra analgesia,the incidence of urinary retention and possible technique-related complications.Data were collected after surgery and outpatient follow-up.Results The postoperative pain scores was much lower in groups A than group B at the time points 12,24,and 48 hours after operation,with statistically significant(P<0.05).The postoperative pain scores during the first two defecation after surgery,were no statistically significant between group A and B(P>0.05).The post-operative complication,demanding extra analgesia and incidences of urinary retention have no statistic difference between groups(P>0.05).Conclusions Obvious effect was obtained after the application of nerve stimulator guided pudendal nerve accurate blocking and better than the traditional wound local anesthesia,its efficacy is exact and with reliable safety,and indicated that it could be widely used in the analgesia for anorectal surgery.