Lukasewycz Stephen, Holman Matt, Kozlowski Paul, Porter Christopher R, Odom Erin, Bernards Chris, Neil Nancy, Corman John M
Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Can J Urol. 2010 Oct;17(5):5377-82.
Robotic assisted laparoscopic radical prostatectomy (RALP) is a common treatment for localized prostate cancer. Despite a primary advantage of improved postoperative pain, patients undergoing RALP still experience discomfort. Belladonna, containing the muscarinic receptor antagonists atropine and scopolamine, in combination with opium as a rectal suppository (B & O) may improve post-RALP pain. This study evaluates whether a single preoperative B & O results in decreased postoperative patient-reported pain and analgesic requirements.
Patients undergoing RALP at Virginia Mason Medical Center between November 2008 and July 2009 were offered the opportunity to enter a randomized, double-blind, placebo-controlled trial. Exclusion criteria included: glaucoma, bronchial asthma, convulsive disorders, chronic pain, chronic use of analgesics, or a history of alcohol or opioid dependency. Surgeons were blinded to suppository placement which was administered after induction of anesthesia. All patients underwent a standardized anesthesia regimen. Postoperative pain was assessed by a visual analog scale (VAS) and postoperative narcotic use was calculated in intravenous morphine equivalents.
Ninety-nine patients were included in the analysis. The B & O and control groups were not significantly different in terms of age, body mass index, operative time, nerve sparing status or prostatic volume. Postoperative pain was significantly improved during the first two postoperative hours in the B & O group. Similarly, 24-hour morphine consumption was significantly lower in patients who received a B & O. No adverse effects secondary to suppository placement were identified.
Preoperative administration of B & O suppository results in significantly decreased postoperative pain and 24-hour morphine consumption in patients undergoing RALP.
机器人辅助腹腔镜根治性前列腺切除术（RALP）是局限性前列腺癌的常见治疗方法。尽管术后疼痛改善是其主要优势，但接受RALP的患者仍会感到不适。含有毒蕈碱受体拮抗剂阿托品和东莨菪碱的颠茄与鸦片制成直肠栓剂（B&O）可能会改善RALP术后疼痛。本研究评估术前单次使用B&O是否能降低术后患者报告的疼痛及镇痛需求。
2008年11月至2009年7月在弗吉尼亚梅森医疗中心接受RALP的患者有机会参加一项随机、双盲、安慰剂对照试验。排除标准包括：青光眼、支气管哮喘、惊厥性疾病、慢性疼痛、长期使用镇痛药或有酒精或阿片类药物依赖史。外科医生对栓剂放置情况不知情，栓剂在麻醉诱导后给药。所有患者均接受标准化麻醉方案。术后疼痛通过视觉模拟量表（VAS）评估，术后麻醉剂使用量以静脉注射吗啡当量计算。
99例患者纳入分析。B&O组和对照组在年龄、体重指数、手术时间、保留神经情况或前列腺体积方面无显著差异。B&O组术后前两小时的疼痛明显改善。同样，接受B&O的患者24小时吗啡消耗量显著较低。未发现因栓剂放置引起的不良反应。
术前给予B&O栓剂可显著降低接受RALP患者的术后疼痛和24小时吗啡消耗量。
