罗哌卡因复合利多卡因前列腺周围神经阻滞在经会阴前列腺融合穿刺中的应用

Application of ropivacaine and lidocaine in transperineal prostate fusion biopsy related peri-prostatic nerve block

目的联合应用中长效麻醉剂罗哌卡因及短效麻醉剂利多卡因,系统性评价差异化前列腺周围神经阻滞(PPNB)条件下,经会阴前列腺融合穿刺的围手术期麻醉效果,期望建立优化的经会阴前列腺融合穿刺的神经阻滞方法。方法分析2020年8月-2021年4月于西安交通大学第一附属医院泌尿外科行经会阴前列腺融合穿刺的203例患者的临床资料。上述患者按所应用的麻醉剂成分不同分为利多卡因组(单用组)和罗哌卡因+利多卡因组(联用组)。记录、分析2组患者的基线临床特征、围手术期疼痛视觉模拟评分(VAS评分)、生命体征变化(观测时间点分别为穿刺前、会阴麻醉时、探头进入肛门时、PPNB阻滞、穿刺过程中、穿刺完成后1 h和3 h)及术后并发症发生情况。结果联用组VAS评分较单用组在穿刺过程(2.21 vs.2.52分,P=0.036)、穿刺完毕后1 h(0.51 vs.1.53分,P=0.006)及3 h(0.26 vs.1.18分,P=0.025)时低,而在会阴麻醉时(1.97 vs.2.05分,P=0.827)、进入肛门(2.07 vs.2.10分,P=0.729)、PPNB阻滞时(3.01 vs.3.06分,P=0.778)与单用组之间的差异无统计学意义。此外联用组穿刺过程中及穿刺完毕后1 h时,患者收缩压及心率显著低于单用组(收缩压:P=0.038、P=0.045;心率:P=0.045、P=0.036),在其余时间点差异并无统计学意义(均为P>0.05)。结论联合应用中长效麻醉剂罗哌卡因及短效麻醉剂利多卡因,可使经会阴前列腺融合穿刺术患者围手术期疼痛显著降低,是更加适宜的PPNB技术。

Objective To evaluate the effect of combined use of Ropivacaine and Lidocaine on transperineal prostate fusion biopsy(TPFB),so as to establish an effective peri-prostate nerve block(PPNB)method.Methods Clinical data of 203 patients who underwent TPFB during Aug.2020 and Apr.2021 were prospectively analyzed.The patients were divided into lidocaine group(single-drug group)and Ropivacaine+Lidocaine group(combination group)randomly.The baseline clinical cha-racteristics of the two groups were recorded and analyzed,including VAS score,changes of vital signs(observation times were before biopsy,during perineal anesthesia,when probe entering anus,during PPNB,during biopsy,1 h and 3 h after biopsy),and postoperative complications.Results The VAS score was significantly decreased in combination group during biopsy(2.21 vs.2.52,P=0.036),1 h after biopsy(0.51 vs.1.53,P=0.006)and 3 h after biopsy(0.26 vs.1.18,P=0.025)(P<0.05).No significant differences in VAS scores were observed during perineal anesthesia(1.97 vs.2.05,P=0.827),when probe entering anus(2.07 vs.2.10,P=0.729)and during PPNB(3.01 vs.3.06,P=0.778).Moreover,blood pressure and heart rate were significantly decreased in combination group during biopsy and 1 h after biopsy(P<0.05).No significant differences were found at other time points(P>0.05).Conclusion Combining ropivacaine with lidocaine is an effective PPNB method for TPFB.