椎管内与硬膜外镇痛在腹腔镜结直肠手术中的短期疗效比较。
Short-term outcomes with intrathecal versus epidural analgesia in laparoscopic colorectal surgery.
机构信息
Department of Colorectal Surgery, Singleton Hospital, Abertawe Bro Morgannwg University Hospital Trust, Swansea, UK.
出版信息
Br J Surg. 2010 Sep;97(9):1401-6. doi: 10.1002/bjs.7127.
BACKGROUND
Epidural analgesia is the mainstay of perioperative pain management in enhanced recovery programmes. This study compared short-term outcomes following epidural or intrathecal analgesia in patients undergoing elective laparoscopic colorectal surgery.
METHODS
A single-centre observational study was carried out in 175 consecutive patients who had elective laparoscopic colorectal surgery for benign or malignant disease within an enhanced recovery programme. Seventy-six patients received epidural analgesia and 99 had a single injection of intrathecal analgesia to provide perioperative pain control.
RESULTS
Patients who had intrathecal analgesia had a reduced median postoperative pain score compared with those receiving epidural analgesia (0 versus 3.5; P < 0.001), an earlier return to mobility (1 versus 4 days; P < 0.001) and a shorter hospital stay (4 versus 5 days; P < 0.001). Return to normal gut function and postoperative nausea and vomiting were similar in the two groups.
CONCLUSION
Intrathecal analgesia may have advantages over epidural analgesia in patients undergoing laparoscopic colorectal surgery.
背景
硬膜外镇痛是加速康复方案中围手术期疼痛管理的主要手段。本研究比较了接受择期腹腔镜结直肠手术的患者接受硬膜外或鞘内镇痛的短期结局。
方法
在一个加速康复方案中，对 175 例接受择期腹腔镜结直肠手术的良性或恶性疾病患者进行了一项单中心观察性研究。76 例患者接受硬膜外镇痛，99 例患者接受单次鞘内镇痛以提供围手术期疼痛控制。
结果
与接受硬膜外镇痛的患者相比，接受鞘内镇痛的患者术后疼痛评分中位数更低（0 与 3.5；P<0.001），活动恢复更早（1 与 4 天；P<0.001），住院时间更短（4 与 5 天；P<0.001）。两组患者的肠道功能恢复正常和术后恶心呕吐情况相似。
结论
在接受腹腔镜结直肠手术的患者中，鞘内镇痛可能优于硬膜外镇痛。
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