Omar Sohaila H, Radwan Khalda G, Youssif Maha A, Khafagy Hanan F, Kamal Nabaweya M, El-Sabae Hossam H, Kamel Hend H
Department of Anesthesiology, Theodor Bilharz Research Institute, Imbaba P.O.B. 30, Giza, Egypt.
J Egypt Soc Parasitol. 2009 Dec;39(3):849-64.
Fast-tracking implies a preoperative patient care paradigm that reduces time to recovery and discharge. The current study adopted fast-track anesthetic techniques, comparing outcome of a multimodal non-opioid and another opioid regimen, on recovery profiles after colonic surgery, with standard anesthetic practice. Seventy five ASA II colectomy patients were randomly assigned to one of three groups. Control group for conventional general anesthetic technique and two fast-track anesthesia groups using combined light general anesthesia and epidural techniques. Epidural maintenance was by infusion cocktail of bupivacaine-fentanyl in opioid-based group, while in non-opioid group by bupivacaine-ketamine which were both continued postoperatively for pain in lower doses and concentrations. Postoperative analgesia in control group was achieved by morphine. Supplemental ketorolac and acetaminophen were added only to non-opioid group. Early and intermediate recovery profiles were compared among the three groups together with recorded side effects. All patients in fast-track groups had significant shorter times to: awakening, extubation, orientation, both PACU arrival and discharge, hospital stay with a significant lower mean VAS for pain at rest, and rescue analgesia, compared to control group. Control group had a significant higher rate of postoperative nausea & vomiting, drowsiness and pruritus. Non-opioid fast-track regimen had a significant shorter PACU and hospital stay with lower side-effects rate than opioid one. Fast-track anesthesia enhanced recovery profile. Non-opioid regimen was superior to opioid-based, having a better recovery profile and a lower rate of side-effects.
快速康复意味着一种术前患者护理模式，可缩短恢复和出院时间。本研究采用快速康复麻醉技术，将多模式非阿片类药物方案和另一种阿片类药物方案的结肠手术后恢复情况与标准麻醉实践进行比较。75例美国麻醉医师协会（ASA）分级为II级的结肠切除术患者被随机分为三组。一组为传统全身麻醉技术对照组，另外两组为采用浅全身麻醉与硬膜外技术联合的快速康复麻醉组。在阿片类药物组中，硬膜外维持采用布比卡因-芬太尼混合液输注，而在非阿片类药物组中采用布比卡因-氯胺酮，术后均以较低剂量和浓度持续用于镇痛。对照组术后镇痛通过吗啡实现。仅在非阿片类药物组中添加了补充性酮咯酸和对乙酰氨基酚。比较了三组的早期和中期恢复情况以及记录的副作用。与对照组相比，快速康复组的所有患者在以下方面的时间均显著缩短：苏醒、拔管、定向、进入和离开麻醉后恢复室（PACU）、住院时间，静息时平均视觉模拟评分（VAS）疼痛显著降低，以及急救镇痛。对照组术后恶心呕吐、嗜睡和瘙痒的发生率显著更高。非阿片类药物快速康复方案的PACU停留时间和住院时间显著更短，副作用发生率低于阿片类药物方案。快速康复麻醉改善了恢复情况。非阿片类药物方案优于阿片类药物方案，恢复情况更好，副作用发生率更低。
