不同肌松方案对机器人辅助腹腔镜手术患者术后肩痛的影响

doi:10.3969/j.issn.1006-5725.2024.17.018

Abstract

Abstract:

Objective To compare the impact of continuous profound neuromuscular blockade versus conventional neuromuscular blockade on postoperative shoulder pain in patients undergoing robot?assisted laparoscopic surgery during steep Trendelenburg position. Methods This study was a single?center， randomized， double?blind clinical trial. The inclusion criteria encompassed individuals aged between 18 and 80 years， with an American Society of Anesthesiologists status of Ⅰ or Ⅱ， and a body mass index ranging from 18 kg/m² to 30 kg/m². A total of one hundred patients were randomly assigned to either the deep neuromuscular blockade group （D group） or the conventional neuromuscular blockade group （C group）， with equal distribution of fifty cases in each group. Rocuronium dosage was titrated to achieve post?tetanic count values of 1 ~ 2 and train?of?four stimulation levels of 1 ~ 2 during surgery for D and C groups respectively. At the end of surgery， sugammadex was administered for reversal of neuromuscular blockade. The primary endpoint assessed the incidence of postoperative shoulder pain within three days after surgery. Secondary endpoints included Leiden score evaluation during intraoperative period， number of additional neuromuscular blockers required by the surgeon， recovery time for muscle relaxation postoperatively， nausea and vomiting scores during recovery phase， visual analog scale （VAS） scores in Post?Anesthesia Care Unit （PACU） as well as within three days after surgery， incidence rate for postoperative pulmonary complications， length of hospital stay duration and patient satisfaction score. Results The incidence of postoperative shoulder pain was significantly lower in group D compared to group C （D group 32% vs. C group 56%；P < 0.05）. However， there were no significant differences in postoperative shoulder pain VAS scores between the two groups （P > 0.05）. No significant differences were observed between the groups in terms of Leiden score， surgeon's requirement for additional neuromuscular blockers， nausea and vomiting in PACU， and VAS score （P > 0.05）. Group D exhibited better early postoperative activity pain scores than group C （P < 0.05）. There were no significant differences in VAS scores between the groups at other time points （P > 0.05）. Furthermore， there were no significant differences in the incidence of postoperative pulmonary complications， length of stay， and satisfaction scores between the two groups. Conclusion The implementation of continuous deep neuromuscular blockade in patients undergoing robot?assisted laparoscopic surgery with steep Trendelenburg position can effectively mitigate the occurrence of postoperative shoulder pain.

Key words: continue deep neuromuscular blockade, conventional neuromuscular blockade, steep trendelenburg position, postoperative shoulder pain, robotassisted laparoscopic surgery

CLC Number:

R614

Meixiao FAN,Minjuan ZHANG,Shasha PANG,Shan HE,Zhihong LU,Dong. XING. Effect of neuromuscular blockade protocol on postoperative shoulder pain in patients undergoing robot⁃assisted laparoscopic surgery： A single⁃center randomized controlled clinical trial[J]. The Journal of Practical Medicine, 2024, 40(17): 2460-2464.

Figures/Tables 6

Tab.1

Comparison of baseline characteristics between two groups"

项目	D组（n = 50）	C组（n = 50）	t/χ²值	P值
年龄（ $x ˉ$ ± s）/岁	54.6 ± 12.0	58.5 ± 10.6	-1.71	0.63
性别/［例（%）］			1.00	0.32
男	22（44）	27（54）
女	28（56）	23（46）
BMI（ $x ˉ$ ± s）/（kg/m²）	22.6 ± 2.5	22.4 ± 2.4	0.82	0.06
ASA分级/［例（%）］			0.67	0.41
Ⅰ级	18（36）	22（40）
Ⅱ级	32（64）	28（60）
手术类型［例（%）］			1.00	0.32
前列腺癌手术	22（44）	27（54）
妇科肿瘤手术	28（56）	23（46）

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

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指标	D组（n = 50）	C组（n = 50）	t/Z/χ²值	P值
术前TOF基线值［M（P₂₅，P₇₅）］	116（105，129）	114（102，126）	0.15	0.78
手术时间（x ± s）/min	193.9 ± 50.3	196.2 ± 45.0	-0.24	0.30
麻醉时间（x ± s）/min	238.4 ± 56.1	240.7 ± 46.7	-0.23	0.24
气腹压（x ± s）/mmHg	13.3 ± 0.8	13.0 ± 1.0	0.13	0.82
罗库溴铵剂量（x ± s）/mg	110.0 ± 24.1	77.0 ± 7.5	9.36	< 0.001
舒芬太尼（x ± s）/μg	26.8 ± 4.8	25.9 ± 4.2	0.99	0.26
液体输注量（x ± s）/mL
晶体液	1 606.0 ± 328.0	1 685.0 ± 317.0	-1.23	0.27
胶体液	340.0 ± 235.6	354.0 ± 194.0	-1.12	0.12
舒更葡糖钠［例（%）］	50（100）	2（4）	92.31	< 0.001

组别	肩痛［例（%）］	术后肩痛VAS评分
组别	肩痛［例（%）］	24 h	48 h	72 h
D组	16（32）	0（0，0.25）	0（0，0）	0（0，0）
C组	28（56）	0（0，1）	0（0，1）	0（0，0）
Z/χ²值	5.84	-1.51	-1.86	-1.42
P值	0.02	0.13	0.06	0.16

组别	术中		术后		PACU内
组别	Leiden评分	追加肌松次数	术后TOF值（x ± s）	TOF恢复至 > 0.9时间（x ± s，min）	恶心呕吐评分	VAS评分
D组	4.5（4.0，5.0）	0（0，0）	110.2 ± 8.1	2.1 ± 0.8	0（0，0）	2.5（0，4）
C组	5.0（4.0，5.0）	0（0，1）	102.4 ± 5.2	4.6 ± 1.0	0（0，0）	3（2.8，4）
t/Z值	-0.19	-1.09	-1.29	-1.42	-0.06	-1.15
P值	0.85	0.28	0.01	0.03	0.95	0.08

组别	术后VAS评分
组别	24 h静卧	24 h翻身	48 h静卧	48 h翻身	72 h静卧	72 h翻身
D组	0（0，3）	4（3，5）	0（0，2）	3（1，4）	0（0，0.25）	2（1，3）
C组	0（0，2）	5（3，6）	0（0，3）	4（3，5）	0（0，0.5）	2（0，4）
t/Z值	-5.00	-2.98	-2.62	-2.12	-1.90	-2.00
P值	0.62	0.003	0.06	0.08	0.07	0.07

组别	住院时间（x ± s）/d	满意度评分［M（P₂₅，P₇₅）］/分
D组	4.7 ± 1.3	9（9，10）
C组	5.1 ± 1.9	10（9，10）
t/Z值	-1.22	-1.34
P值	0.05	0.06

Effect of neuromuscular blockade protocol on postoperative shoulder pain in patients undergoing robot⁃assisted laparoscopic surgery： A single⁃center randomized controlled clinical trial

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