Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Urology. 2010 Nov;76(5):1122-4. doi: 10.1016/j.urology.2010.03.052. Epub 2010 Jun 8.
Minimally invasive surgical techniques have many benefits, including reduced postoperative pain. Despite this, most patients require opioid analgesia, which can have significant side effects and toxicity. We report the first urologic study using multimodal analgesia with pregabalin, a gabapentinoid.
The present retrospective study included 60 patients who underwent robotic-assisted laparoscopic radical prostatectomy. Of the 60 patients, 30 received multimodal treatment with pregabalin 150 mg, acetaminophen 975 mg, and celecoxib 400 mg orally 2 hours before the start of the procedure and continued postoperatively. These patients were compared with 30 consecutive previous patients, who had received a standard postoperative analgesic regimen with intravenous ketorolac 15 mg every 6 hours with oxycodone 5 mg and acetaminophen 325 mg, 1 to 2 tablets, every 4 hours as needed for pain.
The patients in the multimodal treatment group had a significantly reduced intraoperative opioid requirement, as measured by the mean morphine equivalent dose administered (38.4 ± 2.73 mg vs 49.1 ± 2.65 mg; P < .01). The mean postoperative opioid use was also significantly reduced (10.7 ± 2.82 mg vs 26.2 ± 6.56 mg; P = .034), as was the mean total morphine equivalent dose administered (49.1 ± 2.7 mg vs 75.3 ± 4.6 mg; P < .001). The operative time, estimated operative blood loss, antiemetic use, postoperative creatinine and hemoglobin levels, and length of stay were similar in the 2 groups. No operative or treatment complications occurred in either group.
The present retrospective review has indicated that a multimodal analgesic approach with pregabalin and celecoxib administered preoperatively decreases intraoperative and postoperative opioid use in patients undergoing robotic-assisted laparoscopic radical prostatectomy.
微创外科技术有许多优点，包括术后疼痛减轻。尽管如此，大多数患者仍需要阿片类镇痛药，而这可能会产生显著的副作用和毒性。我们报告首例使用普瑞巴林（一种加巴喷丁类药物）进行多模式镇痛的泌尿科研究。
本回顾性研究纳入了 60 例行机器人辅助腹腔镜根治性前列腺切除术的患者。其中 30 例患者接受普瑞巴林 150mg、对乙酰氨基酚 975mg 和塞来昔布 400mg 多模式治疗，在手术开始前 2 小时口服，并在术后继续使用。这些患者与 30 例连续的先前患者进行比较，这些患者接受了标准的术后镇痛方案，即每 6 小时静脉注射酮咯酸 15mg，同时每 4 小时口服羟考酮 5mg 和对乙酰氨基酚 325mg，按需使用 1 至 2 片。
多模式治疗组患者的术中阿片类药物需求量显著减少，表现为平均吗啡等效剂量（38.4±2.73mg 比 49.1±2.65mg；P<.01）。术后阿片类药物的平均使用量也显著减少（10.7±2.82mg 比 26.2±6.56mg；P=0.034），以及平均总吗啡等效剂量（49.1±2.7mg 比 75.3±4.6mg；P<.001）。两组患者的手术时间、估计手术失血量、止吐药使用、术后肌酐和血红蛋白水平以及住院时间相似。两组均未发生手术或治疗相关并发症。
本回顾性研究表明，术前给予普瑞巴林和塞来昔布的多模式镇痛方法可减少行机器人辅助腹腔镜根治性前列腺切除术患者的术中及术后阿片类药物使用。
