超声引导下椎板后路阻滞对后腹腔镜肾切除术不同性别患者术后镇痛效果的比较

Comparison of the effect of ultrasound-guided retrolaminar block in different genders with retroperitoneal laparoscopic nephrectomy

目的对比观察超声引导下椎板后路阻滞(Retrolaminar block,RLB)在后腹腔镜肾切除术后不同性别的术后镇痛效果和康复情况。方法椎板后路阻滞下后腹腔镜肾切除术患者57例,年龄18~65岁,ASA I或II级,按性别分为两组,A组(男性)28例,B组(女性)29例。两组均于全麻诱导后在超声引导下在术侧行RLB,药物采用0.4%罗哌卡因30 mL,术后均采用同一标准配方的舒芬太尼PCIA。记录术后2、4、6、24、48 h的VAS评分、术后PACU停留时间、镇痛泵有效按压次数、术后首次下床活动时间、术后疼痛炎症相关因子等。结果术后2、4、6、24、48h A组镇痛泵有效按压次数明显少于B组(P<0.05),住院总费用明显少于B组(P<0.05)。结论超声引导下椎板后阻滞在后腹腔镜肾切除术中不同性别间存在差异,对于男性术后镇痛效果更明显,术后阿片类药物的需求更少。

Objective To observe and compare the therapeutic effects of ultrasound-guided retrolaminar block(RLB)in patients of different genders with laparoscopic nephrectomy.Methods Fifty-seven patients aged 18~65 years,ASA I or II,were divided into two groups:A group(male)28 and B group(female)29.Both groups underwent RLB at the operative side under ultrasonic guidance after induction of general anesthesia,the drug was 0.4%ropivacaine 30ml,sufentanil PCIA with the same standard formula was used postoperatively.At 2,4,6,24 and 48h after surgery,VAS scores,the time at the PACU after operation,effective pressure times of analgesia pump,time of first postoperative ambulation,and postoperative pain,as well as inflammation related factors,were recorded.Results Effective pressure times of analgesia pump at 2,4,6,24 and 48h after operation were significantly less in group A than in group B(P<0.05),Total hospitalization costs were significantly less than group B(P<0.05).Conclusion Ultrasound-guided retrolamina block in laparoscopic nephrectomy differs between the sexes.Postoperative analgesia was more effective in men,meanwhile there was less need for opoids after surgery.