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.	来源, 葛继涛, 张锦. 全凭静脉麻醉与全凭吸入麻醉在小儿日间短小手术中不同气道管理方法的对比研究. 武警后勤学院学报(医学版), 2016, 25(12): 994-997, 1006.
4.	刘琳. 分析在妇科宫腔镜手术中使用腰麻和全麻的效果. 中国继续医学教育, 2019, 11(33): 98-100.
5.	贺端端, 贾东林. 日间手术患者术后镇痛临床进展. 中国疼痛医学杂志, 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.	吴尚青, 马建新, 赵静淳, 等. 宫颈旁阻滞联合表面麻醉在浅全麻宫腔镜检查中的有效性及安全性分析. 中国计划生育和妇产科, 2020, 12(3): 52-55.
9.	中华医学会麻醉学分会“成人日间手术加速康复外科麻醉管理专家共识”工作小组. 成人日间手术加速康复外科麻醉管理专家共识. 协和医学杂志, 2019, 10(6): 562-569.
10.	方欣, 郑超, 刘国亮, 等. 超声引导下 IINB 复合全麻用于儿童腹股沟疝日间手术效果观察. 山东医药, 2017, 57(4): 9-12.
11.	史辛波, 郑戈, 徐佳, 等. 瑞芬太尼、舒芬太尼全凭静脉麻醉在妇科腹腔镜手术中的应用. 局解手术学杂志, 2015(1): 52-54, 55.
12.	郭浩翔. 七氟醚喉罩全麻与丙泊酚静脉全麻在无痛宫腔镜手术中的应用效果比较. 临床医学工程, 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, 帅训军, 等. 丙泊酚复合不同剂量阿芬太尼用于无痛人流术的临床观察. 临床麻醉学杂志, 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, 欧阳铭文, 王海棠. BIS 反馈闭环路靶控输注右美托咪定可减少丙泊酚用量. 南方医科大学学报, 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. 来源, 葛继涛, 张锦. 全凭静脉麻醉与全凭吸入麻醉在小儿日间短小手术中不同气道管理方法的对比研究. 武警后勤学院学报(医学版), 2016, 25(12): 994-997, 1006.
4. 刘琳. 分析在妇科宫腔镜手术中使用腰麻和全麻的效果. 中国继续医学教育, 2019, 11(33): 98-100.
5. 贺端端, 贾东林. 日间手术患者术后镇痛临床进展. 中国疼痛医学杂志, 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. 吴尚青, 马建新, 赵静淳, 等. 宫颈旁阻滞联合表面麻醉在浅全麻宫腔镜检查中的有效性及安全性分析. 中国计划生育和妇产科, 2020, 12(3): 52-55.
9. 中华医学会麻醉学分会“成人日间手术加速康复外科麻醉管理专家共识”工作小组. 成人日间手术加速康复外科麻醉管理专家共识. 协和医学杂志, 2019, 10(6): 562-569.
10. 方欣, 郑超, 刘国亮, 等. 超声引导下 IINB 复合全麻用于儿童腹股沟疝日间手术效果观察. 山东医药, 2017, 57(4): 9-12.
11. 史辛波, 郑戈, 徐佳, 等. 瑞芬太尼、舒芬太尼全凭静脉麻醉在妇科腹腔镜手术中的应用. 局解手术学杂志, 2015(1): 52-54, 55.
12. 郭浩翔. 七氟醚喉罩全麻与丙泊酚静脉全麻在无痛宫腔镜手术中的应用效果比较. 临床医学工程, 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, 帅训军, 等. 丙泊酚复合不同剂量阿芬太尼用于无痛人流术的临床观察. 临床麻醉学杂志, 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, 欧阳铭文, 王海棠. BIS 反馈闭环路靶控输注右美托咪定可减少丙泊酚用量. 南方医科大学学报, 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

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