腹腔镜肝切除术鞘内镇痛术后疼痛的回顾性分析

贵州医科大学  麻醉与心脏电生理课题组

翻译：陈锐   编辑：张中伟   审校：曹莹

01

背景

鞘内镇痛(Ia)已被促进术后恢复学会（ERAS）推荐用于腹腔镜结肠切除术；然而，尽管IA用于开腹肝切除术，但其在腹腔镜肝胆手术中尚未得到广泛研究。这项回顾性分析是为了探讨接受腹腔镜肝切除术(LLR)的患者在48小时内的术后疼痛，这些患者接受IA加或不加病人自控镇痛(IA±PCA)或仅接受PCA。

02

方法

经伦理学批准后，回顾2016年1月至2019年4月间接受腰椎间盘突出症(LLR)且仅有IA±PCA或PCA的成人患者的图表。排除有注释吗啡禁忌症、阻塞性睡眠呼吸暂停、体重指数>40 kg/m2、慢性疼痛史和/或吸毒史的患者。描述性统计用于描述每种疼痛结果的治疗组术后48小时的疼痛水平。

03

结果

111例患者中，最终纳入79例，其中22例为IA±PCA，57例为单纯PCA。在基线特征、非阿片类止痛药物的使用和术后并发症方面，两组之间没有统计学上的显著差异。IA的使用与术后阿片类药物消耗(口服吗啡当量)相比减少(平均差值[95%可信区间]-45.92[-83.10to-8.75]；P=0.016)。

04

结论

IA有可能减少LLR患者术后阿片类药物的使用，在LLR的使用中似乎是安全有效的。这些发现与ERAS协会推荐的腹腔镜结直肠手术是一致的。

05

原始文献来源

liu AY , vanniyasingam T, tidy A, Yao W, shin D, serrano Pe, et al. Postoperative pain after intrathecal analgesia in laparoscopic liver resection: a retrospective chart review. Minerva Anestesiol 2021;87:856-63. DOI:10.23736/S0375-9393.21.15255-1

英文原文

Postoperative pain after intrathecal analgesia

in laparoscopic liver resection:

a retrospective chart review

Abstract

Background: Intrathecal analgesia (IA) has been recommended by the enhanced recovery after surgery (ERAS) Society for laparoscopic colon resections; however, although IA is used in open liver resections, it has not been extensively studied in laparoscopic hepatobiliary surgery. This retrospective chart review was undertaken to explore postoperative pain within 48 hours among patients who underwent laparoscopic liver resections (LLR), receiving either IA with or without patient-controlled analgesia (IA±PCA) versus PCA alone.

Methods: After ethics approval, charts were reviewed for adult patients who underwent LLR between January 2016 and April 2019, and had IA±PCA or PCA alone. Patients with any contraindication to IA with morphine, obstructive sleep apnea, body mass index >40 kg/m2, history of chronic pain, and/or history of drug use were excluded. Descriptive statistics used to describe postoperative pain levels at 48 hours by treatment group for each pain outcome.

Results: Of 111 patients identified, 79 patients were finally included; 22 patients had IA±PCA and 57 patients had PCA only. There were no statistically significant differences in baseline characteristics, use of non-opioid pain control, and postoperative complications between the two groups. IA use was associated with reduced postoperative opioid consumption (measured in oral morphine equivalents) compared to PCA alone (mean difference [95% confidence interval] -45.92 [-83.10 to -8.75]; P=0.016).

Conclusions: IA has the potential to decrease postoperative opioid use for patients undergoing LLR, and appears to be safe and effective in the setting of LLR. These findings are consistent with the ERAS Society recommendations for laparoscopic colorectal surgery.

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