神经阻滞对预防经尿道钬激光前列腺剜除术的男性患者术后膀胱痉挛及导管相关膀胱不适的影响

贵州医科大学    麻醉与心脏电生理课题组

翻译：安丽  编辑：张中伟  审校：曹莹

背景：膀胱痉挛（BS）和导管相关膀胱不适 （CRBD） 是经尿道钬激光前列腺剜除术（HoLEP）的术后并发症。阴部神经（PN）支配会阴部。因此，我们评估了PN阻滞（PNB）是否可以降低HoLEP的患者BS和CRBD的发生率。

方法：在这项随机、平行、单盲前瞻性研究中，我们纳入了110 名择期全麻下行HoLEP的患者。患者被随机分为PNB组（超声引导下于阴部（Alcock’s）管入口处行双侧PNB；n = 55）和对照组（仅全身麻醉；n = 55）。主要指标是术后0.5、1、2、4、6、12和24小时BS和CRBD的发生率。次要指标为CRBD的严重程度、术后疼痛和镇痛药的使用情况。P < 0.05差异具有统计学意义。

结果：PNB组术后24小时内BS（P=0.023）和CRBD（P <0.001）的发生率显著降低。PNB组术后0.5h（P < 0.001）、1h（P < 0.001）、2h（P < 0.001）和4h（P = 0.019）中度以上CRBD的发生率显著降低。此外，PNB组术后疼痛评分和镇痛药使用显著降低。未观察到PNB相关并发症。

结论：在接受HoLEP且无PNB相关副作用的患者中，阴部管入口处行双侧PNB有助于降低BS和CRBD的发生率，减少术后疼痛及镇痛药物的使用。

原始文献来源：Wang SY, Qiu Q, Shen X. Effect of Pudendal Nerve Block on the Prevention of Postoperative Bladder Spasm and Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Holmium Laser Enucleation of the Prostate. Clin Interv Aging. 2022;17:1729-1738.

英文原文 

Effect of Pudendal Nerve Block on the Prevention of Postoperative Bladder Spasm and Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Holmium Laser Enucleation of the Prostate

Abstract

Purpose Bladder spasm (BS) and catheter-related bladder discomfort (CRBD) are complications after transurethral holmium laser enucleation of the prostate (HoLEP). The pudendal nerve (PN) innervates the perineum. Therefore, we evaluated whether PN block (PNB) can reduce the incidence of BS and CRBD in patients undergoing HoLEP.

Methods In this randomized, parallel, single-blind prospective study, we enrolled 110 patients who were scheduled to undergo HoLEP under general anesthesia. Patients were randomly allocated to the PNB group (ultrasound-guided PNB at the entrance of the pudendal [Alcock’s] canal bilaterally; n = 55) or the control group (general anesthesia only; n = 55). The primary outcome was the incidence of BS and CRBD at 0.5, 1, 2, 4, 6, 12, and 24 hours postoperatively. The CRBD severity, postoperative pain, and analgesic drug use were also assessed. A P value of < 0.05 was considered statistically significant.

Results A significantly lower incidence of BS (P = 0.023) and CRBD (P < 0.001) was reported within the first 24 hours postoperatively in the PNB group. The incidence of CRBD above a moderate grade at 0.5 (P < 0.001), 1 (P < 0.001), 2 (P < 0.001), and 4 (P = 0.019) hours postoperatively was significantly lower in the PNB group. Additionally, postoperative pain scores and analgesic drug use were significantly lower in the PNB group. No PNB-related complications were observed.

Conclusion PNB at the entrance of the pudendal canal bilaterally resulted in a lower incidence of BS and CRBD, less postoperative pain, and less analgesic drug use in patients undergoing HoLEP without PNB-related side effects.