Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
J Pediatr Surg. 2011 May;46(5):870-3. doi: 10.1016/j.jpedsurg.2011.02.019.
Open transumbilical pyloromyotomy (UMBP) and laparoscopic pyloromyotomy (LAP) have been compared on different outcomes, but postoperative pain as a primary end point had never been assessed. The aim of this study was to compare the use of analgesia in UMBP and LAP patients.
Infants with hypertrophic pyloric stenosis treated by UMBP in 2008-2009 were matched with LAP-treated infants. Demographics, type and use of analgesia, and length of stay were recorded. Statistical analysis was performed using the Fisher exact test.
Each group contained 19 patients (N = 38) with comparable demographics and no comorbid condition. Bupivacaine was injected intraoperatively in all UMBP and 89% of LAP infants. There was a trend toward increased acetaminophen use in LAP infants (79% vs 58%, P = .61) in the recovery room. There was no difference in opiates use (3 UMBP vs 1 LAP, P = .60). In the ward, more UMBP patients received acetaminophen (78% vs 53%, P = .03). This difference was significant. Mean postoperative length of stay was similar in both groups.
Our study suggests that UMBP infants might experience more postoperative pain in the ward, without any impact on various outcomes. A prospective study with a larger sample size should be undertaken to verify these findings.
经脐开放式幽门肌切开术（UMBP）和腹腔镜幽门肌切开术（LAP）已在不同的结果上进行了比较，但从未评估过术后疼痛作为主要终点。本研究的目的是比较 UMBP 和 LAP 患者的镇痛使用情况。
2008 年至 2009 年间，对接受 UMBP 治疗的肥厚性幽门狭窄婴儿进行了匹配，并与接受 LAP 治疗的婴儿进行了比较。记录了人口统计学、镇痛类型和使用情况以及住院时间。使用 Fisher 精确检验进行统计分析。
每组各有 19 例患儿（N=38），具有可比的人口统计学特征，且无合并症。所有 UMBP 患儿和 89%的 LAP 患儿均在术中注射布比卡因。在恢复室中，LAP 患儿使用对乙酰氨基酚的趋势增加（79%比 58%，P=.61）。阿片类药物的使用无差异（3 例 UMBP 比 1 例 LAP，P=.60）。在病房中，更多的 UMBP 患儿接受了对乙酰氨基酚（78%比 53%，P=.03）。这一差异具有统计学意义。两组患儿的术后平均住院时间相似。
我们的研究表明，UMBP 患儿在病房中可能会经历更多的术后疼痛，但对各种结果没有影响。应该进行一项前瞻性研究，以验证这些发现。
