Department of Colorectal Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.
Colorectal Dis. 2010 Feb;12(2):119-24. doi: 10.1111/j.1463-1318.2009.01768.x. Epub 2009 Jan 16.
The study set out to analyse the outcomes of an evolving accelerated recovery programme after laparoscopic colorectal resection (LCR).
The results of a prospective electronic database (March 2000 - April 2008) were analysed.
There were 353 consecutive patients undergoing 'three port' high anterior resection (AR) (237 without covering stoma) and 166 a right hemicolectomy (RHC). One hundred thirty-eight had postoperative analgesia using paracetamol IV and oral analgesia (IVP); 27 (16.3%) received additional parenteral morphine and were excluded. Patient controlled morphine analgesia (PCA) was used in 138. Transversus abdominis plane (TAP) blocks, supplemented by IV paracetamol and oral analgesia were used in the last 50 patients. The time to the resumption of diet was significantly reduced with TAP analgesia (median 12 h) and IVP (median 12 h) compared with PCA median (36 h) (chi(2) = 143; 4df: P < 0.001). The postoperative hospital stay was significantly reduced with TAP analgesia (median 2 days) and IVP (median 3 days) compared with PCA (median 5 days); chi(2) = 73; 2df: P < 0.001. Seventeen (34%) TAP and nine (6.5%) IVP patients were discharged within 24 h of surgery compared with no patient in the PCA group. Ninety-three per cent of PCA, 35% IVP and 10% TAP patients were discharged in more than 3 days. The movement towards 'accelerated recovery' was not associated with any increased risk of urinary retention, return to theatre, readmission and/or 30 day mortality.
Laparoscopic surgery utilizing IV paracetamol and TAP blocks for postoperative analgesia aids safe effective 'accelerated recovery' in an unselected patient population undergoing right hemicolectomy and high anterior resection. Routine epidural anaesthesia is unnecessary for LCR. Morphine PCA is associated with delayed recovery.
本研究旨在分析腹腔镜结直肠切除术后（LCR）不断发展的加速康复方案的结果。
分析了一个前瞻性电子数据库（2000 年 3 月至 2008 年 4 月）的结果。
连续 353 例患者行“三孔”高位前切除术（AR）（237 例无覆盖造口）和 166 例右半结肠切除术（RHC）。138 例患者术后使用静脉注射对乙酰氨基酚（IVP）和口服镇痛（IVP）进行镇痛；27 例（16.3%）患者接受额外的静脉注射吗啡治疗，被排除在外。138 例患者使用患者自控吗啡镇痛（PCA）。在最后 50 例患者中，使用腹横肌平面（TAP）阻滞，辅以 IV 对乙酰氨基酚和口服镇痛。与 PCA 组（中位数 36 小时）相比，TAP 镇痛（中位数 12 小时）和 IVP（中位数 12 小时）的饮食恢复时间明显缩短（chi(2) = 143；4df：P < 0.001）。与 PCA 组（中位数 5 天）相比，TAP 镇痛（中位数 2 天）和 IVP（中位数 3 天）的术后住院时间明显缩短；chi(2) = 73；2df：P < 0.001。17 例（34%）TAP 和 9 例（6.5%）IVP 患者在术后 24 小时内出院，而 PCA 组没有患者出院。93%的 PCA、35%的 IVP 和 10%的 TAP 患者在 3 天以上出院。向“加速康复”发展与尿潴留、重返手术室、再次入院和/或 30 天死亡率增加无关。
腹腔镜手术中使用 IV 对乙酰氨基酚和 TAP 阻滞进行术后镇痛有助于在未选择的右半结肠切除术和高位前切除术患者中安全有效地实现“加速康复”。常规硬膜外麻醉对于 LCR 是不必要的。吗啡 PCA 与恢复延迟有关。
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