Alvarez Martin P, Foley Katherine E, Zebley D Mark, Fassler Steven A
Department of Surgery, Abington Memorial Hospital, 1200 Old York Road, Price Bldg, Suite 604, Abington, PA, 19001, USA,
Surg Endosc. 2015 Sep;29(9):2506-11. doi: 10.1007/s00464-014-4006-8. Epub 2014 Dec 6.
A comprehensive enhanced recovery pathway (ERP) was implemented in patients undergoing laparoscopic colectomy in an attempt to reduce postoperative opioid consumption. We hypothesized that improved local analgesia and increased use of non-opioid pain medication, combined with earlier feeding and ambulation, would allow for earlier return of bowel function and shorter postoperative length of stay (LOS).
We retrospectively reviewed 89 patients who underwent elective partial laparoscopic colectomy with our ERP fully integrated compared to a historical control group of 162 patients. Differences between the ERP and control groups average return of bowel function, postoperative LOS, opioid medication usage, and complications were compared statistically using the student's t-test and Fisher exact test. Pain was controlled with the laparoscope-guided transversus abdominis plane (TAP), scheduled doses of non-narcotic medications, and reserved use of opioids. Patient, nursing and resident education regarding all aspects of the ERP was emphasized.
Patients in the ERP group had a significant decrease of opioid usage, earlier return of bowel function, and shorter postoperative hospital LOS. Opioid use was reduced from 75 to 19 mg I.V. morphine (p = 0.0001). Patients had an average return of bowel function of 0.66 days earlier from postoperative day (POD) 2.99 to POD 2.33 (p = 0.0001) and were discharged from the hospital 1 day sooner on POD 2.7 compared with POD 3.7 (p = 0.0013). There was no statistically significant difference in postoperative complications between the control and ERP groups.
The new ERP, including TAP block and postoperative pain medication protocol limiting I.V. narcotics, is effective in controlling pain in elective partial laparoscopic colectomy. Pain control management together with regimented early feeding and ambulation allow for significantly earlier return of bowel function and shorter postoperative LOS.
为减少腹腔镜结肠切除术患者术后阿片类药物的使用量，实施了一项全面的强化康复方案（ERP）。我们推测，改善局部镇痛、增加非阿片类止痛药物的使用，结合早期进食和活动，将使肠道功能更早恢复，术后住院时间（LOS）缩短。
我们回顾性分析了89例行择期部分腹腔镜结肠切除术且完全采用ERP方案的患者，并与162例历史对照组患者进行比较。使用学生t检验和Fisher精确检验对ERP组和对照组在肠道功能平均恢复时间、术后LOS、阿片类药物使用情况及并发症方面的差异进行统计学比较。通过腹腔镜引导下的腹横肌平面阻滞（TAP）、非麻醉药物的定时给药以及阿片类药物的按需使用来控制疼痛。强调了对患者、护士和住院医生进行有关ERP各方面的教育。
ERP组患者的阿片类药物使用量显著减少，肠道功能恢复更早，术后住院时间更短。阿片类药物的使用量从75毫克静脉注射吗啡减少至19毫克（p = 0.0001）。患者肠道功能平均恢复时间从术后第2.99天提前至第2.33天，提前了0.66天（p = 0.0001），出院时间较对照组提前1天，分别为术后第2.7天和第3.7天（p = 0.0013）。对照组和ERP组术后并发症无统计学显著差异。
新的ERP，包括TAP阻滞和限制静脉注射麻醉剂的术后疼痛药物方案，在择期部分腹腔镜结肠切除术中有效控制疼痛。疼痛控制管理与规律的早期进食和活动相结合，可使肠道功能显著更早恢复，术后LOS缩短。
Zotero 插件