Sved Paul D, Nieder Alan M, Manoharan Murugesan, Gomez Pablo, Meinbach David S, Kim Sandy S, Soloway Mark S
Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA.
Urology. 2005 Mar;65(3):509-12. doi: 10.1016/j.urology.2004.09.063.
To analyze the postoperative pain, analgesic requirements, and convalescence of patients undergoing radical retropubic prostatectomy (RRP) under spinal anesthesia using long-acting morphine sulfate as preemptive analgesia.
A total of 103 consecutive men underwent RRP by a single surgeon. The time to tolerate oral fluids, time to unassisted ambulation, postoperative pain levels (visual analog pain score of 0 to 10), and analgesic requirements expressed in morphine equivalents were evaluated. Baseline patient characteristics and intraoperative factors (operating room time, blood loss) were also evaluated.
The mean time to tolerate oral fluids and unassisted ambulation was 11.3 +/- 7.6 hours and 20 +/- 6 hours, respectively. The mean narcotic requirements were 7.4 +/- 6.1 morphine equivalents before discharge and 28.5 +/- 25.9 morphine equivalents in the first week after discharge. The mean visual analog pain score was 4.5 +/- 2.1 at discharge and fell significantly to 1.5 +/- 1.0 by the time of Foley catheter removal on postoperative day 7 or 8. The analgesic requirements after discharge correlated with the pain score at discharge (P = 0.016). The mean time to resumption of normal preoperative activities was 19.4 +/- 9.4 days. Two patients developed postspinal anesthesia headache. No other complications attributable to the anesthetic occurred.
RRP may be performed through a small modified Pfannenstiel incision under spinal anesthesia containing long-acting morphine with little postoperative pain, low narcotic requirements, and a short convalescence. A prospective, randomized study is needed to compare the early postoperative outcomes of RRP performed using general versus spinal anesthesia.
分析在蛛网膜下腔麻醉下使用长效硫酸吗啡进行超前镇痛的耻骨后根治性前列腺切除术（RRP）患者的术后疼痛、镇痛需求及康复情况。
共有103名连续的男性患者由同一位外科医生进行RRP手术。评估患者耐受口服液体的时间、独立行走的时间、术后疼痛程度（视觉模拟疼痛评分0至10分）以及以吗啡当量表示的镇痛需求。同时评估患者的基线特征和术中因素（手术时间、失血量）。
耐受口服液体和独立行走的平均时间分别为11.3±7.6小时和20±6小时。出院前平均麻醉药物需求量为7.4±6.1吗啡当量，出院后第一周为28.5±25.9吗啡当量。出院时视觉模拟疼痛评分的平均值为4.5±2.1，在术后第7或8天拔除Foley导管时显著降至1.5±1.0。出院后的镇痛需求与出院时的疼痛评分相关（P = 0.016）。恢复术前正常活动的平均时间为19.4±9.4天。两名患者发生了蛛网膜下腔麻醉后头痛。未发生其他与麻醉相关的并发症。
RRP可在含有长效吗啡的蛛网膜下腔麻醉下通过改良的小Pfannenstiel切口进行，术后疼痛轻、麻醉药物需求低且康复期短。需要进行一项前瞻性随机研究来比较全身麻醉与蛛网膜下腔麻醉下RRP的早期术后结果。
