单侧腹横肌平面阻滞缓解男性全身麻醉后导尿管相关膀胱不适的效果

Efficacy of unilateral ilioinguinal transversus abdominis plane block for alleviation of catheter-related bladder discomfort in male patients after emergence from general anesthesia:a prospective,randomized controlled trial

目的:探讨超声引导下单侧髂腹股沟腹横肌平面阻滞(TAPB)缓解男性全身麻醉后导尿管相关膀胱不适(CRBD)的效果。方法:选择全身麻醉术后在麻醉复苏室(PACU)留置期间出现重度CRBD男性患者62例,随机分为对照组(C组)和TAPB组(T组)。C组予以静脉注射舒芬太尼0.15μg/kg,T组在超声引导下使用0.375%罗哌卡因10 mL行单侧髂腹股沟TAPB。采用4分制评估法评价治疗后0.5 h、1 h、2 h和6 h CRBD的严重程度,当CRBD评级为中重度时,予以静脉注射曲马多1 mg/kg作为补救措施,记录生命体征,并观察患者有无恶心、呕吐、眩晕、镇静过度、呼吸抑制等不良反应。结果:T组中重度CRBD发生率在治疗后0.5 h、1 h、2 h和6 h均显著低于C组(P<0.05)。与C组相比,T组治疗后镇静过度和呼吸抑制的发生率显著降低(P<0.05),需要静脉注射曲马多作为补救措施的患者也明显减少(P<0.05)。结论:应用0.375%罗哌卡因行单侧髂腹股沟TAPB可降低男性患者全身麻醉术后CRBD的严重程度,并减少镇痛药的使用以及不良反应的发生。

Objective:To investigate urinary catheterization frequently leading to catheter-related bladder discomfort(CRBD)in male patients after general anesthesia,and to prove the efficacy of unilateral ilioinguinal transversus abdominis plane block(TAPB)in attenuating CRBD in male patients.Methods:Male patients with a severe CRBD were randomized to receive unilateral ilioinguinal TAPB with 0.375%ropivacaine 10 mL(group T)or intravenous sufentanil 0.15μg/kg(group C).The primary outcomes were the severity of CRBD at 0.5,1,2,and 6 hours after treatment,and the other outcomes included the postoperative adverse events related to treatments.In addition,postoperative pain and need for analgesic drug were recorded.Tramadol was given to patients with moderate to severe CRBD.The findings were compared between the two Groups.Results:The incidence of moderate-to-severe CRBD in group T was significantly lower than in group C at 0.5,1,2,and 6 hours after treatment.The need for tramadol in Group T was significantly less than Group C(P<0.05).The postoperative incidences of sedation and respiratory depression were decreased significantly in group T,compared with group C(P<0.05).Conclusion:Unilateral ilioinguinal TAPB with ropivacaine could decrease the severity of CRBD and reduce the need for rescue agent.It could also reduce the incidence of agent-related complications in male patients after general anesthesia as compared with the therapy of intravenous sufentanil.