Recart Alejandro, Duchene David, White Paul F, Thomas Tojo, Johnson D Brooke, Cadeddu Jeffrey A
Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas 75399-9068, USA.
J Endourol. 2005 Dec;19(10):1165-9. doi: 10.1089/end.2005.19.1165.
Factors that adversely affect early recovery after major laparoscopic procedures include ileus, pain, nausea, emesis, and fatigue. The objective of this randomized controlled study was to evaluate the impact of a multimodal fast-track (FT) rehabilitation program on recovery and length of hospital stay after laparoscopic nephrectomy.
Thirty patients undergoing laparoscopic nephrectomy received either conventional care (control) or an FT recovery program. All patients received a standardized anesthetic technique and patient- controlled analgesia (morphine) for postoperative pain control. In the FT group, patients received premedication with rofecoxib and ranitidine, local anesthesia was administered at the ports and renal fosa during surgery, and postoperative non-opioid analgesic and gastrokinetic drugs were administered as part of an early enteral nutrition and mobilization program. During the postoperative period, pain and nausea were assessed at specific time intervals. In addition, recovery room and hospital discharge times, the need for rescue analgesics and antiemetics, patient satisfaction with pain management and quality of recovery, and side effects were recorded daily for 3 days after surgery. Patients were discharged home when they met previously defined discharge criteria.
The FT group was discharged earlier from the recovery room (74+/-23 v 103+/-47 minutes) and the hospital (41+/-11 v 59+/-11 hours). Pain and nausea scores were consistently lower in the FT group during the first 48 hours after surgery. In addition, the requirement for antiemetic rescue therapy during the first 24 hours was reduced in the FT group (15% v 58%). The FT group also received less morphine during the first 2 postoperative days (14+/-16 v 40+/-24 mg). Finally, patient satisfaction with postoperative pain control was significantly higher in the FT group.
A multimodal approach to minimizing postoperative side effects led to a reduced recovery room and hospital stay, as well as better pain control and patient satisfaction after laparoscopic nephrectomy.
影响大型腹腔镜手术后早期恢复的不利因素包括肠梗阻、疼痛、恶心、呕吐及疲劳。本随机对照研究的目的是评估多模式快速康复（FT）康复计划对腹腔镜肾切除术后恢复及住院时间的影响。
30例行腹腔镜肾切除术的患者接受常规护理（对照组）或FT康复计划。所有患者均接受标准化麻醉技术及患者自控镇痛（吗啡）以控制术后疼痛。FT组患者术前给予罗非昔布和雷尼替丁，术中在切口和肾窝处给予局部麻醉，术后非阿片类镇痛药及胃肠动力药作为早期肠内营养和活动计划的一部分使用。术后期间，在特定时间间隔评估疼痛和恶心情况。此外，记录术后3天每天的恢复室和出院时间、使用解救镇痛药和止吐药的需求、患者对疼痛管理和恢复质量的满意度以及副作用。患者达到先前定义的出院标准后出院回家。
FT组从恢复室出院更早（74±23对103±47分钟），住院时间也更短（41±11对59±11小时）。术后48小时内FT组的疼痛和恶心评分始终较低。此外，FT组术后24小时内使用止吐解救治疗的需求减少（15%对58%）。FT组术后前两天使用的吗啡也更少（14±16对40±24毫克）。最后，FT组患者对术后疼痛控制的满意度显著更高。
采用多模式方法减少术后副作用可缩短腹腔镜肾切除术后的恢复室停留时间和住院时间，并实现更好的疼痛控制和患者满意度。
