Chaykovska Lyubov, Blohmé Linus, Mayer Dieter, Gloekler Steffen, Rancic Zoran, Schmidt Christian A P, Tunesi Roberto, Veith Frank, Lachat Mario, Bettex Dominique
Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
Ann Vasc Surg. 2014 May;28(4):837-44. doi: 10.1016/j.avsg.2013.11.019. Epub 2014 Jan 20.
Opiates are widely used for postoperative pain relief. Unfortunately, their side effects such as inhibited gastrointestinal motility and respiratory depression may compromise or delay postoperative recovery after laparotomy. We used paraincisional subcutaneous catheters (PSCs) and applied 0.25% ropivacaine infusion to improve pain relief and decrease postoperative morphine consumption in patients after open surgery for aortic aneurysm.
A retrospective single-center study including 58 patients treated by open surgery for aortic aneurysm between October 2006 and June 2012. Overall, 28 patients (control group) received standard postoperative pain management including opiates, and 30 patients (PSC group) were treated with paraincisional continuous local analgesia with 0.25% ropivacaine administrated via bilateral subcutaneous catheters along with additional ad libitum opiates administration, at first intravenously and then orally.
Patients characteristics as well as perioperative and postoperative outcomes were comparable between the groups during the first 5 days after surgery. Patients of the PSC group received significantly less morphine, although the patients in both groups reported a similar pain intensity. Neither wound-healing disorder nor catheter-associated subcutaneous infection was reported. High serum concentration of ropivacaine was detected in 2 patients (6%) with end-stage renal disease, who developed temporary neurologic symptoms. Length of intensive care unit (ICU) stay was significantly shorter in the PSC group (2 [0-23] vs. 4.5 [0-32] ICU days).
This is the first report about PSCs for analgesia after laparotomy. This case/control study shows that continuous paraincisional subcutaneous infusion of 0.25% ropivacaine after open surgery for aortic aneurysm repair is a feasible method of postoperative analgesia. This technique allows sustained pain relief with significant reduction of opiate requirement and faster recovery after surgery. Prospective randomized controlled trial is necessary for the assessment of safety and efficacy of this method.
阿片类药物广泛用于术后疼痛缓解。不幸的是，它们的副作用如抑制胃肠蠕动和呼吸抑制可能会损害或延迟剖腹手术后的恢复。我们使用切口旁皮下导管（PSC）并应用0.25%罗哌卡因输注，以改善疼痛缓解并减少主动脉瘤开放手术后患者的术后吗啡用量。
一项回顾性单中心研究，纳入了2006年10月至2012年6月期间接受主动脉瘤开放手术治疗的58例患者。总体而言，28例患者（对照组）接受包括阿片类药物在内的标准术后疼痛管理，30例患者（PSC组）通过双侧皮下导管给予0.25%罗哌卡因进行切口旁持续局部镇痛，并额外按需给予阿片类药物，起初静脉给药，然后口服给药。
两组患者在术后第1个5天内的患者特征以及围手术期和术后结局具有可比性。PSC组患者接受的吗啡显著较少，尽管两组患者报告的疼痛强度相似。未报告伤口愈合障碍或导管相关皮下感染。2例（6%）终末期肾病患者检测到高血清罗哌卡因浓度，他们出现了短暂的神经症状。PSC组重症监护病房（ICU）住院时间显著更短（2 [0 - 23]天 vs. 4.5 [0 - 32]天）。
这是关于剖腹手术后PSC用于镇痛的首篇报道。这项病例/对照研究表明，主动脉瘤修复开放手术后通过切口旁持续皮下输注0.25%罗哌卡因是一种可行的术后镇痛方法。该技术可实现持续的疼痛缓解，显著减少阿片类药物需求并加快术后恢复。有必要进行前瞻性随机对照试验来评估该方法的安全性和有效性。
