Application of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia_West China Medical Journal

Authors：

SU Quancai ,  LANG Bao

Department of Anesthesiology, Weifang People’s Hospital, Weifang, Shandong 261000, P. R. China;

Corresponding?author：

LANG Bao, Email: wfsrmyymz@126.com

Keywords：

Paracervical block; alfentanil; day surgery

DOI：

10.7507/1002-0179.202101014

Video：

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Objective To investigate the efficacy and safety of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia. Methods This study used a prospective randomized controlled study approach. A total of 60 day surgery patients requiring hysteroscopic surgery under general anesthesia admitted to Weifang People’s Hospital between October and December 2020 were randomly selected. All patients were divided into trial group and control group by completely random number table method, with 30 patients in each group. The trial group received paracervical block combined with total intravenous anesthesia with alfentanil, and the control group received total intravenous anesthesia with alfentanil. The general condition, operation time, recovery time, intraoperative propofol dosage, postoperative pain score, intraoperative motion response and postoperative nausea and vomiting incidence were compared between the two groups. Results There was no significant difference in age, body mass index and incidence of comorbidities between the two groups (P>0.05). There was no significant difference in the operation time, recovery time, pain score at 2 hours after operation, and incidence of nausea and vomiting between the two groups (P>0.05). In the control group, the dose of propofol [(34.07±12.67) vs. (28.33±9.10) mL], the pain score on awakening (1.50±0.78 vs. 0.77±0.50), and the incidence of body movement response (20.0 % vs. 0.0%) were higher than the trial group (P<0.05). Conclusion The use of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia can reduce the amount of propofol during the operation, reduce postoperative pain, and reduce perioperative adverse reactions, which has a good efficacy and safety.

Citation： SU Quancai, LANG Bao. Application of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia. West China Medical Journal, 2022, 37(2): 204-207. doi: 10.7507/1002-0179.202101014 Copy

1.	Promberger R, Simek IM, Nouri K, et al. Accuracy of tubal patency assessment in diagnostic hysteroscopy compared with laparoscopy in infertile women: a retrospective cohort study. J Minim Invasive Gynecol, 2018, 25(5): 794-799.
2.	Zhang Y, Gu X, Meng Y, et al. Analysis of the effect of laparoscopy and hysteroscopy on ovarian function, immune function and quality of sexual life of patients with hysteromyoma at different ages. Oncol Lett, 2018, 15(3): 2929-2934.
3.	來源, 葛繼濤, 張錦. 全憑靜脈麻醉與全憑吸入麻醉在小兒日間短小手術中不同氣道管理方法的對比研究. 武警后勤學院學報(醫學版), 2016, 25(12): 994-997, 1006.
4.	劉琳. 分析在婦科宮腔鏡手術中使用腰麻和全麻的效果. 中國繼續醫學教育, 2019, 11(33): 98-100.
5.	賀端端, 賈東林. 日間手術患者術后鎮痛臨床進展. 中國疼痛醫學雜志, 2012, 18(2): 113-115.
6.	Krauss P, Marahori NA, Barth F, et al. Scalp block versus local infiltration anesthesia for skull-pin placement in DBS surgery: better hemodynamics and less antihypertensive medication?. J Neurol Surg Part A, 2018, 79(S1): S1-S27.
7.	Raft J, Richebé P. Anesthesia for thoracic ambulatory surgery. Curr Opin Anaesthesiol, 2019, 32(6): 735-742.
8.	吳尚青, 馬建新, 趙靜淳, 等. 宮頸旁阻滯聯合表面麻醉在淺全麻宮腔鏡檢查中的有效性及安全性分析. 中國計劃生育和婦產科, 2020, 12(3): 52-55.
9.	中華醫學會麻醉學分會“成人日間手術加速康復外科麻醉管理專家共識”工作小組. 成人日間手術加速康復外科麻醉管理專家共識. 協和醫學雜志, 2019, 10(6): 562-569.
10.	方欣, 鄭超, 劉國亮, 等. 超聲引導下 IINB 復合全麻用于兒童腹股溝疝日間手術效果觀察. 山東醫藥, 2017, 57(4): 9-12.
11.	史辛波, 鄭戈, 徐佳, 等. 瑞芬太尼、舒芬太尼全憑靜脈麻醉在婦科腹腔鏡手術中的應用. 局解手術學雜志, 2015(1): 52-54, 55.
12.	郭浩翔. 七氟醚喉罩全麻與丙泊酚靜脈全麻在無痛宮腔鏡手術中的應用效果比較. 臨床醫學工程, 2019, 26(6): 743-744.
13.	O’Flynn H, Murphy LL, Ahmad G, et al. Pain relief in outpatient hysteroscopy: a survey of current UK clinical practice. Eur J Obstet Gynecol Reprod Biol, 2011, 154(1): 9-15.
14.	Cooper NA, Khan KS, Clark TJ. Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis. BMJ, 2010, 340: c1130.
15.	Majholm B, Bartholdy J, Clausen HV, et al. Comparison between local anaesthesia with remifentanil and total intravenous anaesthesia for operative hysteroscopic procedures in day surgery. Br J Anaesth, 2012, 108(2): 245-253.
16.	Centini G, Calonaci A, Lazzeri L, et al. Parenterally administered moderate sedation and paracervical block versus general anesthesia for hysteroscopic polypectomy: a pilot study comparing postoperative outcomes. J Minim Invasive Gynecol, 2015, 22(2): 193-198.
17.	Frampton JE, McTavish D. Mivacurium. A review of its pharmacology and therapeutic potential in general anaesthesia. Drugs, 1993, 45(6): 1066-1089.
18.	Ezzine S, Donati F, Varin F. Mivacurium arteriovenous gradient during steady state infusion in anesthetized patients. Anesthesiology, 2002, 97(3): 622-629.
19.	Nauheimer D, Fink H, Fuchs-Buder T, et al. Muscle relaxant use for tracheal intubation in pediatric anaesthesia: a survey of clinical practice in Germany. Paediatr Anaesth, 2009, 19(3): 225-231.
20.	王明玲, 滕莉, 帥訓軍, 等. 丙泊酚復合不同劑量阿芬太尼用于無痛人流術的臨床觀察. 臨床麻醉學雜志, 2012, 28(3): 249-251.
21.	Kranke P, Eberhart LH. Postoperative nausea and vomiting: rational algorithms for prevention and treatment based on current evidence. Anasthesiol Intensivmed Notfallmed Schmerzther, 2009, 44(4): 286-294, quiz 295.
22.	Lu CH, Wu ZF, Lin BF, et al. Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery. J Neurosurg Spine, 2016, 24(2): 268-274.
23.	梁芳果, 歐陽銘文, 王海棠. BIS 反饋閉環路靶控輸注右美托咪定可減少丙泊酚用量. 南方醫科大學學報, 2015, 35(10): 1497-1500.
24.	Kadoi Y, Saito S. Effects of adding remifentanil to propofol anesthesia on systemic hemodynamics, cardiac output, and middle cerebral artery flow velocity during electroconvulsive therapy: a pilot study. J ECT, 2015, 31(2): 98-100.

1. Promberger R, Simek IM, Nouri K, et al. Accuracy of tubal patency assessment in diagnostic hysteroscopy compared with laparoscopy in infertile women: a retrospective cohort study. J Minim Invasive Gynecol, 2018, 25(5): 794-799.
2. Zhang Y, Gu X, Meng Y, et al. Analysis of the effect of laparoscopy and hysteroscopy on ovarian function, immune function and quality of sexual life of patients with hysteromyoma at different ages. Oncol Lett, 2018, 15(3): 2929-2934.
3. 來源, 葛繼濤, 張錦. 全憑靜脈麻醉與全憑吸入麻醉在小兒日間短小手術中不同氣道管理方法的對比研究. 武警后勤學院學報(醫學版), 2016, 25(12): 994-997, 1006.
4. 劉琳. 分析在婦科宮腔鏡手術中使用腰麻和全麻的效果. 中國繼續醫學教育, 2019, 11(33): 98-100.
5. 賀端端, 賈東林. 日間手術患者術后鎮痛臨床進展. 中國疼痛醫學雜志, 2012, 18(2): 113-115.
6. Krauss P, Marahori NA, Barth F, et al. Scalp block versus local infiltration anesthesia for skull-pin placement in DBS surgery: better hemodynamics and less antihypertensive medication?. J Neurol Surg Part A, 2018, 79(S1): S1-S27.
7. Raft J, Richebé P. Anesthesia for thoracic ambulatory surgery. Curr Opin Anaesthesiol, 2019, 32(6): 735-742.
8. 吳尚青, 馬建新, 趙靜淳, 等. 宮頸旁阻滯聯合表面麻醉在淺全麻宮腔鏡檢查中的有效性及安全性分析. 中國計劃生育和婦產科, 2020, 12(3): 52-55.
9. 中華醫學會麻醉學分會“成人日間手術加速康復外科麻醉管理專家共識”工作小組. 成人日間手術加速康復外科麻醉管理專家共識. 協和醫學雜志, 2019, 10(6): 562-569.
10. 方欣, 鄭超, 劉國亮, 等. 超聲引導下 IINB 復合全麻用于兒童腹股溝疝日間手術效果觀察. 山東醫藥, 2017, 57(4): 9-12.
11. 史辛波, 鄭戈, 徐佳, 等. 瑞芬太尼、舒芬太尼全憑靜脈麻醉在婦科腹腔鏡手術中的應用. 局解手術學雜志, 2015(1): 52-54, 55.
12. 郭浩翔. 七氟醚喉罩全麻與丙泊酚靜脈全麻在無痛宮腔鏡手術中的應用效果比較. 臨床醫學工程, 2019, 26(6): 743-744.
13. O’Flynn H, Murphy LL, Ahmad G, et al. Pain relief in outpatient hysteroscopy: a survey of current UK clinical practice. Eur J Obstet Gynecol Reprod Biol, 2011, 154(1): 9-15.
14. Cooper NA, Khan KS, Clark TJ. Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis. BMJ, 2010, 340: c1130.
15. Majholm B, Bartholdy J, Clausen HV, et al. Comparison between local anaesthesia with remifentanil and total intravenous anaesthesia for operative hysteroscopic procedures in day surgery. Br J Anaesth, 2012, 108(2): 245-253.
16. Centini G, Calonaci A, Lazzeri L, et al. Parenterally administered moderate sedation and paracervical block versus general anesthesia for hysteroscopic polypectomy: a pilot study comparing postoperative outcomes. J Minim Invasive Gynecol, 2015, 22(2): 193-198.
17. Frampton JE, McTavish D. Mivacurium. A review of its pharmacology and therapeutic potential in general anaesthesia. Drugs, 1993, 45(6): 1066-1089.
18. Ezzine S, Donati F, Varin F. Mivacurium arteriovenous gradient during steady state infusion in anesthetized patients. Anesthesiology, 2002, 97(3): 622-629.
19. Nauheimer D, Fink H, Fuchs-Buder T, et al. Muscle relaxant use for tracheal intubation in pediatric anaesthesia: a survey of clinical practice in Germany. Paediatr Anaesth, 2009, 19(3): 225-231.
20. 王明玲, 滕莉, 帥訓軍, 等. 丙泊酚復合不同劑量阿芬太尼用于無痛人流術的臨床觀察. 臨床麻醉學雜志, 2012, 28(3): 249-251.
21. Kranke P, Eberhart LH. Postoperative nausea and vomiting: rational algorithms for prevention and treatment based on current evidence. Anasthesiol Intensivmed Notfallmed Schmerzther, 2009, 44(4): 286-294, quiz 295.
22. Lu CH, Wu ZF, Lin BF, et al. Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery. J Neurosurg Spine, 2016, 24(2): 268-274.
23. 梁芳果, 歐陽銘文, 王海棠. BIS 反饋閉環路靶控輸注右美托咪定可減少丙泊酚用量. 南方醫科大學學報, 2015, 35(10): 1497-1500.
24. Kadoi Y, Saito S. Effects of adding remifentanil to propofol anesthesia on systemic hemodynamics, cardiac output, and middle cerebral artery flow velocity during electroconvulsive therapy: a pilot study. J ECT, 2015, 31(2): 98-100.

West China Medical Journal

Application of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia

Abstract Full text Figures/Tables Video References Cited by

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