Senagore A J, Delaney C P, Mekhail N, Dugan A, Fazio V W
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Br J Surg. 2003 Oct;90(10):1195-9. doi: 10.1002/bjs.4223.
This randomized clinical trial compared the use of thoracic epidural anaesthesia-analgesia (TEA) with morphine patient-controlled analgesia (PCA) for pain relief after laparoscopic colectomy.
Patients scheduled for segmental laparoscopic colectomy were randomized to receive TEA or PCA. Patients in the TEA group received bupivacaine and fentanyl before incision and after surgery by continuous infusion for 18 h. Patients in the PCA group self-administered morphine using an intravenous pump. The postoperative care plan was otherwise identical for the two groups. Postoperative pain was measured during ambulation using a visual analogue pain score.
The study included 38 patients (18 TEA, 20 PCA), 16 of whom underwent right hemicolectomy or ileocolectomy and 22 sigmoid colectomy. Operating times, patient weight and distribution of American Society of Anesthesiologists grade were similar in the two groups. The mean(s.e.m.) total dose of drugs administered was 64(41) mg morphine in the PCA group, and 79(42) mg bupivacaine and 205(140) micro g fentanyl in the TEA group. Postoperative pain scores were significantly better in the TEA group at 6 h (mean(s.e.m.) 2.2(0.4) versus 6.6(0.5) with PCA; P = 0.001) and 18 h (2.2(0.3) versus 4.0(0.4); P = 0.003). Hospital stay was similar in the two groups.
TEA significantly improved early analgesia following laparoscopic colectomy but did not affect the length of hospital stay.
本随机临床试验比较了胸段硬膜外麻醉镇痛（TEA）与吗啡患者自控镇痛（PCA）用于腹腔镜结肠切除术后疼痛缓解的效果。
计划行节段性腹腔镜结肠切除术的患者被随机分为接受TEA或PCA组。TEA组患者在切口前及术后接受布比卡因和芬太尼持续输注18小时。PCA组患者使用静脉泵自行注射吗啡。两组的术后护理方案相同。术后在患者活动期间使用视觉模拟疼痛评分法测量疼痛程度。
该研究纳入38例患者（18例TEA组，20例PCA组），其中16例行右半结肠切除术或回结肠切除术，22例行乙状结肠切除术。两组的手术时间、患者体重及美国麻醉医师协会分级分布相似。PCA组给药的平均（标准误）总剂量为64（41）mg吗啡，TEA组为79（42）mg布比卡因和205（140）μg芬太尼。TEA组术后6小时（平均（标准误）2.2（0.4），PCA组为6.6（0.5）；P = 0.001）和18小时（2.2（0.3）对4.0（0.4）；P = 0.003）的疼痛评分明显更好。两组的住院时间相似。
TEA显著改善了腹腔镜结肠切除术后的早期镇痛，但不影响住院时间。
