Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA.
Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA.
Gynecol Oncol. 2015 Jan;136(1):77-81. doi: 10.1016/j.ygyno.2014.10.015. Epub 2014 Oct 23.
There is a lack of consistent data regarding gynecologic oncology (GO) patients and the use of neuraxial anesthesia for post-operative pain management. Our objective was to compare the use of continuous epidural infusion (CEI) as part of post-operative pain management to more traditional management schemes.
GO patients undergoing laparotomy from July 1st, 2011 through July 31st, 2012 were identified. Patient demographic data and peri-operative details were abstracted from the medical record. The primary outcome was a mean patient visual analog pain score. Secondary outcomes included length of stay, post-operative urinary tract infection (UTI) and venous thromboembolic (VTE) events.
There were 237 laparotomies during the study time period. Fifty-six women had CEI for post-operative pain management and 181 did not. Patients with CEI had lower pain scores on POD #0 (3.8 vs 5.3, p < 0.01), #1 (2.6 vs 4.0, p < 0.01) and #2 (2.5 vs 3.5, p < 0.01) compared to women without CEI. There was no difference in the length of stay between those with and without CEI (103 vs 94 h, p = 0.32). Women with CEI did have a longer length of urinary catheterization (56 vs 26 h, p = 0.01) but not an increased rate of UTI (5.5% vs 1.8%, p = 0.24). There was a higher rate of post-operative VTE events among women with CEI (8.9% vs 1.7%, p = 0.02).
In this small series, GO patients undergoing laparotomy had improved post-operative pain control when their analgesia regimen included CEI. However, the higher rate of VTE events among CEI users is concerning and merits further investigation.
妇科肿瘤学（GO）患者在术后疼痛管理中使用脊麻的相关数据并不一致。我们的目的是比较连续硬膜外输注（CEI）作为术后疼痛管理的一部分与更传统的管理方案的使用情况。
从 2011 年 7 月 1 日至 2012 年 7 月 31 日，我们对接受剖腹手术的 GO 患者进行了鉴定。从病历中提取患者的人口统计学数据和围手术期详细信息。主要结果是患者视觉模拟疼痛评分的平均值。次要结果包括住院时间、术后尿路感染（UTI）和静脉血栓栓塞（VTE）事件。
在研究期间，共有 237 例剖腹手术。56 名女性接受 CEI 用于术后疼痛管理，181 名女性未接受 CEI。与未接受 CEI 的女性相比，接受 CEI 的女性在术后第 0 天（3.8 对 5.3，p < 0.01）、第 1 天（2.6 对 4.0，p < 0.01）和第 2 天（2.5 对 3.5，p < 0.01）的疼痛评分较低。接受和未接受 CEI 的女性的住院时间无差异（103 对 94 小时，p = 0.32）。接受 CEI 的女性导尿管留置时间较长（56 对 26 小时，p = 0.01），但 UTI 发生率无差异（5.5%对 1.8%，p = 0.24）。接受 CEI 的女性术后 VTE 事件发生率较高（8.9%对 1.7%，p = 0.02）。
在本小系列中，接受剖腹手术的 GO 患者在其镇痛方案中包含 CEI 时，术后疼痛控制得到改善。然而，CEI 使用者中更高的 VTE 事件发生率令人担忧，需要进一步调查。
