Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada.
Liver Transpl. 2011 Mar;17(3):315-23. doi: 10.1002/lt.22221.
Despite the increase in surgical volumes of live liver donation, there has been very little documentation of the postoperative pain experience. The primary aim of this study was to examine the difference in acute postoperative pain intensity and adverse effects between patients who received intravenous patient-controlled analgesia (IV PCA) or patient-controlled epidural analgesia (PCEA) for pain control after live liver donation surgery. A retrospective chart review was performed of 226 consecutive patients who underwent right living donor hepatic surgery at the Toronto General Hospital, Toronto, Canada. Patients who received as their primary postoperative analgesic modality IV PCA (n = 158) were compared to patients who received PCEA (n = 68). Demographic profiles for the 2 groups were similar with respect to age, sex, and body mass index at the time of surgery. For the first 3 postoperative days, pain intensity was significantly lower in patients who received epidural analgesia (P < 0.01). Clinically significant moderate pain (defined as a Numeric Rating Scale pain score >4) was reported more frequently in the IV PCA group (P < 0.05) along with increased sedation (P < 0.05). Pruritus was reported more frequently in the PCEA group of patients compared to the IV PCA group (P < 0.05). Significant between-group differences were not found for the incidence of postoperative vomiting, the time at which patients began fluid intake, the time to initial ambulation, or the length of hospital stay. In conclusion, epidural analgesia provides better postoperative pain relief, less sedation, but more pruritus than IV PCA after live liver donation.
尽管活体肝移植手术量有所增加，但术后疼痛体验的相关文献却很少。本研究的主要目的是比较静脉患者自控镇痛（IV PCA）和患者自控硬膜外镇痛（PCEA）用于活体肝移植术后患者疼痛控制的急性术后疼痛强度和不良反应差异。对加拿大多伦多总医院连续 226 例接受右活体供肝手术的患者进行回顾性病历审查。将接受 IV PCA 作为主要术后镇痛方式的患者（n = 158）与接受 PCEA 的患者（n = 68）进行比较。2 组患者的人口统计学特征在年龄、性别和手术时的体重指数方面相似。在术后 3 天内，接受硬膜外镇痛的患者疼痛强度明显较低（P < 0.01）。IV PCA 组报告的中度疼痛（定义为数字评分量表疼痛评分 >4）更频繁（P < 0.05），同时镇静程度更高（P < 0.05）。与 IV PCA 组相比，PCEA 组患者更常报告瘙痒（P < 0.05）。两组之间在术后呕吐的发生率、开始摄入液体的时间、首次下床活动的时间或住院时间方面无显著差异。总之，与 IV PCA 相比，硬膜外镇痛在活体肝移植后能提供更好的术后镇痛效果、更少的镇静作用，但瘙痒发生率更高。
