供体肾切除术的疼痛程度如何？开放手术、腹腔镜手术与后腹腔镜手术肾切除术中早期疼痛及疼痛管理的回顾性分析。
How painful is donor nephrectomy? Retrospective analysis of early pain and pain management in open versus laparoscopic versus retroperitoneoscopic nephrectomy.
作者信息
Bachmann Alexander, Wolff Thomas, Giannini Olivier, Dickenman Michael, Ruszat Robin, Gürke Lorenz, Kaufmann Mark, Gasser Thomas C, Steiger Jürg, Stief Christian G, Sulser Tullio
机构信息
Department of Urology, University Hospital Basel, Basel, Switzerland.
出版信息
Transplantation. 2006 Jun 27;81(12):1735-8. doi: 10.1097/01.tp.0000225800.69089.b4.
BACKGROUND
The aim of this study was to evaluate the early postoperative pain and pain management after standard open (ODN), hand-assisted laparoscopic (HLDN) and retroperitoneoscopic (RDN) donor nephrectomy.
METHODS
The visual analogue scale (VAS) was determined twice a day in 203 donors during the first five days after nephrectomy.
RESULTS
Mean VAS was significantly lower after RDN and HLDN than after ODN on day 2 (p=0.004) and days 3-5 (p<0.001). After RDN, "no pain" (VAS=0) was reported significantly earlier than after ODN. Irrespective of the technique used and the pain management, all donors reported significantly higher VAS in the morning. Opiates were administered for a significantly shorter average time period after RDN than after ODN (p=0.005). Cumulative morphine equivalent doses were higher after ODN than after RDN (p=0.001). Mean VAS reported after HLDN and RDN was similar.
CONCLUSIONS
In summary, RDN and HLDN were clearly associated with much less early pain than ODN, independently of the used pain management.
背景
本研究旨在评估标准开放性供体肾切除术（ODN）、手辅助腹腔镜供体肾切除术（HLDN）和后腹腔镜供体肾切除术（RDN）术后早期疼痛及疼痛管理情况。
方法
在203例供体肾切除术后的前五天，每天两次测定视觉模拟评分（VAS）。
结果
在术后第2天（p = 0.004）以及第3 - 5天（p < 0.001），RDN和HLDN术后的平均VAS显著低于ODN术后。RDN术后报告“无疼痛”（VAS = 0）的时间明显早于ODN术后。无论采用何种技术及疼痛管理方式，所有供体报告早晨的VAS显著更高。RDN术后使用阿片类药物的平均时间明显短于ODN术后（p = 0.005）。ODN术后的累积吗啡等效剂量高于RDN术后（p = 0.001）。HLDN和RDN术后报告的平均VAS相似。
结论
总之，与ODN相比，RDN和HLDN明显与更少的早期疼痛相关，与所采用的疼痛管理方式无关。
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