包皮环切术不同麻醉方式的临床疗效

Clinical efficacy of different anesthesia modalities for circumcision

目的 提出并实践了一种新的包皮环切麻醉方式-四点法皮下浸润麻醉,探讨其与另外两种传统麻醉方式临床疗效间的区别,旨在为临床工作中最佳麻醉方式的选择提供依据。方法 采用回顾性分析自2022年4月至2023年7月于山东大学齐鲁医院因包皮过长或包茎行包皮环切术患者150例,均采用一次性包皮环切器行包皮环切术。依据麻醉方式不同分为3组,每组50例。其中A组使用阴茎远端四点皮下浸润麻醉;B组使用阴茎根部皮下环形注射局部浸润麻醉;C组使用复方利多卡因乳膏表面麻醉。比较3组的麻醉操作时间、麻醉起效时间、麻药用量、手术时间、麻醉疼痛评分、手术疼痛评分、术后注射处瘀血、术后注射处水肿及麻药不良反应。结果 A、B与C组在麻醉操作时间、麻醉起效时间、麻药用量、手术时间、麻醉疼痛评分及手术疼痛评分方面,均有统计学差异(P<0.001);A组与B组在麻醉操作时间、麻醉起效时间、麻药用量、手术时间、麻醉疼痛评分、手术疼痛评分、术后注射处瘀血及术后注射处水肿方面,均有统计学差异(P<0.05);A组与C组在麻醉操作时间及手术疼痛评分方面,无统计学差异(P>0.05),在麻醉起效时间、麻药用量、手术时间及麻醉疼痛评分方面,均有统计学差异(P<0.001);B组与C组在麻醉操作时间、麻醉起效时间、麻药用量、手术时间、麻醉疼痛评分及手术疼痛评分方面,均有统计学差异(P<0.001);A、B与C组在年龄、身高、体重、BMI、是否包茎、环切器型号及麻药不良反应方面,均无统计学差异(P>0.05)。结论 阴茎远端四点皮下浸润麻醉具有麻药用量少、手术时间短、疼痛评分低等优点,值得在包皮环切术中推广。

Objective We proposed and practiced a new anesthesia method for circumcision,four-point subcutaneous infiltration anesthesia,to explore the difference between its clinical efficacy and that of two other traditional anesthesia methods,with the aim of providing a basis for the selection of the best anesthesia method in clinical work.Methods In this retrospective study,a total of 150 patients who were circumcised for phimosis or prepuce in Qilu Hospital of Shandong University from April 2022 to July 2023 were included in this study.All of them were circumcised with disposable circumcisers.The patients were divided into three groups according to the different anesthesia methods,with 50 cases in each group.Group A used four-point subcutaneous infiltration anesthesia at the distal penis;Group B used local infiltration anesthesia with subcutaneous circular injection at the root of the penis;Group C used surface anesthesia with compound lidocaine cream.The anesthesia operation time,anesthesia onset time,anesthesia dosage,operation time,anesthesia pain score,operation pain score,postoperative ecchymosis at the injection site,postoperative oedema at the injection site,and the adverse reactions to anesthesia were compared among the three groups,respectively.Results There were statistical differences between Groups A,B and C in terms of anesthesia operation time,anesthesia onset time,anesthetic dosage,operation time,anesthetic pain score and operation pain score(P<0.001);Groups A and B were statistically different in terms of anesthesia operation time,anesthesia onset time,anesthetic dosage,operation time,anesthetic pain score,operation pain score,postoperative ecchymosis at the injection site and postoperative oedema at the injection site(P<0.05);There was no statistical difference between Group A and Group C in terms of anesthesia operation time and surgical pain scores(P>0.05),and there were statistical differences between Group A and Group C in terms of anesthesia onset time,anesthetic dosage,surgical time,anesthetic pain scores and surgical pain scores(P<0.001);There were statistical differences between Group B and Group C in terms of anesthesia operation time,anesthesia onset time,anesthetic dosage,surgical time,anesthetic pain scores and surgical pain scores(P<0.001);There were no statistical differences between Groups A,B and C in terms of age,height,weight,BMI,whether or not they were phimotic,the type of circumciser and adverse reactions to anesthesia(P>0.05).Conclusion Four-point subcutaneous infiltration anesthesia of the distal penis has the advantages of less anesthetic dosage,shorter operative time,and lower pain scores,which is worthy of promotion in circumcision.