Daniil Markaryan, Tatiana Garmanova, Ekaterina Kazachenko, Alexander Lukianov, Eduard Markaryan, Mikhail Agapov
{"title":"痔切除术后增加会阴阻滞是否能加强疼痛控制?一项前瞻性随机双盲安慰剂对照研究。","authors":"Daniil Markaryan, Tatiana Garmanova, Ekaterina Kazachenko, Alexander Lukianov, Eduard Markaryan, Mikhail Agapov","doi":"10.1111/ans.19136","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Haemorrhoidectomy is associated with severe postoperative pain, a long rehabilitation, and QoL worsening for months. Most patients experience mild-to-moderate postoperative pain. We aimed to evaluate the intraoperative perineal block role for patients undergoing haemorrhoidectomy.</p><p><strong>Methods: </strong>In this prospective randomized, double-blind, placebo-controlled study, eligible patients with III-IV stage haemorrhoids were randomized to the experimental group (EG) with intraoperative perineal block and spinal anaesthesia and the control one (CG) only with spinal anaesthesia. During the postoperative period, the opioid consumption rate was evaluated as a primary endpoint, and the postoperative pain level according to VAS, systemic analgesics consumption, readmission, and complication rate, the timing of returning to work, patients' QoL, and overall satisfaction according to SF-36 were evaluated as secondary endpoints.</p><p><strong>Results: </strong>One hundred patients completed the study (48 in EG and 52 in CG). Patients of the EG had less postoperative pain intensity (P < 0.0001), required less opioid analgesia (P = 0.03), and had longer pain-free postoperative periods (P = 0.0002). 90% of patients in the CG required additional NSAID injections for adequate analgesia compared with only 58% in the EG. The average hospital stays, complication rate, and average operation duration didn't reach clinical significance. General health evaluation according to the SF-36 score and the median satisfaction rate was better in the EG (P < 0.001 and P = 0.012, respectively).</p><p><strong>Conclusions: </strong>The administration of the perianal block is safe and effective and should be administered to appropriate patients undergoing anorectal surgery.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does the addition of perineal block enhance pain control after a haemorrhoidectomy? A prospective randomized, double-blind placebo-controlled study.\",\"authors\":\"Daniil Markaryan, Tatiana Garmanova, Ekaterina Kazachenko, Alexander Lukianov, Eduard Markaryan, Mikhail Agapov\",\"doi\":\"10.1111/ans.19136\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Haemorrhoidectomy is associated with severe postoperative pain, a long rehabilitation, and QoL worsening for months. Most patients experience mild-to-moderate postoperative pain. We aimed to evaluate the intraoperative perineal block role for patients undergoing haemorrhoidectomy.</p><p><strong>Methods: </strong>In this prospective randomized, double-blind, placebo-controlled study, eligible patients with III-IV stage haemorrhoids were randomized to the experimental group (EG) with intraoperative perineal block and spinal anaesthesia and the control one (CG) only with spinal anaesthesia. During the postoperative period, the opioid consumption rate was evaluated as a primary endpoint, and the postoperative pain level according to VAS, systemic analgesics consumption, readmission, and complication rate, the timing of returning to work, patients' QoL, and overall satisfaction according to SF-36 were evaluated as secondary endpoints.</p><p><strong>Results: </strong>One hundred patients completed the study (48 in EG and 52 in CG). Patients of the EG had less postoperative pain intensity (P < 0.0001), required less opioid analgesia (P = 0.03), and had longer pain-free postoperative periods (P = 0.0002). 90% of patients in the CG required additional NSAID injections for adequate analgesia compared with only 58% in the EG. The average hospital stays, complication rate, and average operation duration didn't reach clinical significance. General health evaluation according to the SF-36 score and the median satisfaction rate was better in the EG (P < 0.001 and P = 0.012, respectively).</p><p><strong>Conclusions: </strong>The administration of the perianal block is safe and effective and should be administered to appropriate patients undergoing anorectal surgery.</p>\",\"PeriodicalId\":8158,\"journal\":{\"name\":\"ANZ Journal of Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-07-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ANZ Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/ans.19136\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ANZ Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ans.19136","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景:痔切除术会带来剧烈的术后疼痛、漫长的康复过程以及数月的生活质量下降。大多数患者的术后疼痛程度为轻度至中度。我们旨在评估术中会阴阻滞对痔切除术患者的作用:在这项前瞻性随机、双盲、安慰剂对照研究中,符合条件的 III-IV 期痔疮患者被随机分为实验组(EG)和对照组(CG),实验组采用术中会阴阻滞和脊髓麻醉,对照组仅采用脊髓麻醉。在术后期间,阿片类药物消耗率作为主要终点进行评估,术后疼痛程度(根据 VAS)、全身镇痛药消耗量、再入院率、并发症发生率、重返工作岗位的时间、患者的 QoL 以及总体满意度(根据 SF-36 标准)作为次要终点进行评估:100名患者完成了研究(48名EG患者和52名CG患者)。EG 患者的术后疼痛强度较小(P 结论:EG 患者的术后疼痛强度较小,CG 患者的术后疼痛强度较小:实施肛周阻滞是安全有效的,应在合适的肛门直肠手术患者中实施。
Does the addition of perineal block enhance pain control after a haemorrhoidectomy? A prospective randomized, double-blind placebo-controlled study.
Background: Haemorrhoidectomy is associated with severe postoperative pain, a long rehabilitation, and QoL worsening for months. Most patients experience mild-to-moderate postoperative pain. We aimed to evaluate the intraoperative perineal block role for patients undergoing haemorrhoidectomy.
Methods: In this prospective randomized, double-blind, placebo-controlled study, eligible patients with III-IV stage haemorrhoids were randomized to the experimental group (EG) with intraoperative perineal block and spinal anaesthesia and the control one (CG) only with spinal anaesthesia. During the postoperative period, the opioid consumption rate was evaluated as a primary endpoint, and the postoperative pain level according to VAS, systemic analgesics consumption, readmission, and complication rate, the timing of returning to work, patients' QoL, and overall satisfaction according to SF-36 were evaluated as secondary endpoints.
Results: One hundred patients completed the study (48 in EG and 52 in CG). Patients of the EG had less postoperative pain intensity (P < 0.0001), required less opioid analgesia (P = 0.03), and had longer pain-free postoperative periods (P = 0.0002). 90% of patients in the CG required additional NSAID injections for adequate analgesia compared with only 58% in the EG. The average hospital stays, complication rate, and average operation duration didn't reach clinical significance. General health evaluation according to the SF-36 score and the median satisfaction rate was better in the EG (P < 0.001 and P = 0.012, respectively).
Conclusions: The administration of the perianal block is safe and effective and should be administered to appropriate patients undergoing anorectal surgery.
期刊介绍:
ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.