ERAS模式下硬膜外阻滞和腹横肌平面阻滞在老年患者行腹腔镜前列腺癌根治术中的应用比较

Comparison of application of epidural block and transverse abdominis plane block in elderly patients undergoing laparoscopic radical prostatectomy under ERAS mode

目的比较加速康复外科(ERAS)模式下硬膜外阻滞与超声引导下腹横肌平面阻滞对老年患者行腹腔镜前列腺癌根治术的围术期镇痛效果及术后功能恢复情况。方法选择2023年2月—2023年10月于复旦大学附属肿瘤医院择期行腹腔镜前列腺癌根治手术的老年患者120例,使用随机数字表法分为全麻复合硬膜外阻滞组(EA组)和全麻复合腹横肌平面阻滞组(TAP组),每组60例。采用视觉模拟评分(VAS)评估并比较2组患者术后的疼痛程度;观察并比较2组患者围术期舒芬太尼用量、患者胃肠道功能恢复时间(第一次肛门排气和排便的时间、第一次饮水及第一次进食半流质的时间)、患者首次下床活动时间、拔除导尿管时间、住院时间、不良反应和手术并发症发生率。结果因4例患者被剔除研究,最终116例患者被纳入统计。2组患者在术后各个时间点的静息和运动状态下的VAS评分差异均无统计学意义(P>0.05)。2组患者围术期舒芬太尼用量差异无统计学意义(P>0.05)。TAP组患者排气时间、排便时间、进食时间、下地活动时间均明显少于EA组(P<0.05);2组拔尿管时间、住院时间差异无统计学意义(P>0.05)。EA组和TAP组术后不良反应发生率差异无统计学意义(8.62%vs 6.90%,P>0.05);EA组和TAP组手术并发症发生率差异无统计学意义(5.17%vs 3.45%,P>0.05)。结论腹横肌平面阻滞对腹腔镜前列腺癌根治术的老年患者可能提供等同硬膜外麻醉的良好镇痛效果,能促进老年患者胃肠道功能恢复,有利于患者早期下床活动,更加符合ERAS理念。

Objective To compare the perioperative analgesic effects and postoperative functional recovery in elderly patients undergoing laparoscopic radical prostatectomy with epidural block and ultrasound-guided transversus abdominis plane block under accelerated rehabilitation surgery(ERAS)mode.Methods A total of 120 patients who underwent elective laparoscopic radical prostatectomy in Cancer Hospital Affiliated to Fudan University from February 2023 to October 2023 were enrolled.According to random number table method,they were divided into general anesthesia combined with epidural block group(EA group)and general anesthesia combined with transversus abdominis plane block group(TAP group),60 cases in each group.Visual Analogue Scale(VAS)was used to evaluate and compare the postoperative pain degree of the two groups.The dosage of sufentanil used during the perioperative period,the recovery time of gastrointestinal function(the time of first anal exhaust and defecation,the time of first drinking water and the time of eating semi-liquid food),time to get out of bed for the first time,catheter removal time,length of hospital stay,adverse reactions and incidence of surgical complications were observed and compared between the two groups.Results Because 4 patients were excluded from the study,116 ones were finally included in the statistics.There was no significant difference in VAS scores between the two groups at various postoperative time points in both resting and exercising states(P>0.05).There was no statistically significant difference in the dosage of sufentanil used during the perioperative period between the two groups(P>0.05).The exhaust time,defecation time,feeding time and ground activity time of the TAP group were significantly shorter than those of the EA group(P<0.05).There was no significant difference in the catheter removal time and length of hospital stay between the two groups(P>0.05).There was no significant difference in the incidence of postoperative adverse reactions between the EA group and the TAP group(8.62%vs 6.90%,P>0.05).There was no significant difference in the incidence of the surgical complications between the EA group and the TAP group(5.17%vs 3.45%,P>0.05).Conclusion The transversus abdominis plane block may provide a good analgesic effect equivalent to epidural anesthesia for elderly patients undergoing laparoscopic radical prostatectomy.It can promote the recovery of gastrointestinal function in elderly patients,is conducive to the early movement of patients out of bed,and is more in line with the concept of ERAS.