Fustran N, Dalmau A, Ferreres E, Camprubí I, Sanzol R, Redondo S, Kreisler E, Biondo S, Sabaté A
Department of Anaesthesia, Reanimation and Pain Clinic, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
Colorectal Dis. 2015 Apr;17(4):342-50. doi: 10.1111/codi.12893.
The aim of this prospective double-blind randomized clinical trial was to determine whether preperitoneal continuous wound infusion (CWI) of the local anaesthetic ropivacaine after either laparotomy or video-assisted laparoscopy for colorectal surgery would reduce patient consumption of morphine.
Patients scheduled for colorectal surgery randomly received a 48-h preperitoneal CWI of either 0.38% ropivacaine or 0.9% saline at rates of 5 ml/h after laparotomy or 2 ml/h after laparoscopy. The primary end-point was total morphine consumption in surgery and afterwards through a patient-controlled analgesia device. Results in the laparotomy and laparoscopy subgroups were also compared.
Sixty-seven patients were included, 33 in the ropivacaine CWI group and 34 in the saline group. Median [interquartile range (IQR)] morphine consumption was lower in the ropivacaine group [23.5 mg (11.25-42.75)] than in the saline group [52 mg (24.5-64)] (P = 0.010). Morphine consumption was also lower in the laparotomy subgroup receiving ropivacaine [21.5 (15.6-34.7)] than in the saline group [52.5 (22.5-65) ml] (P = 0.041). Consumption was statistically similar in laparoscopy patients on ropivacaine or saline. No side effects were observed. Sixteen patients had a surgical wound infection (23.9%); 11 (16.4%) presented wound infection and five (7.5%) organ space infection. Forty-six catheter cultures were obtained; 10 (21.7%) were positive, assessed to be due to contamination.
Preperitoneal CWI of ropivacaine is a good, safe addition to a multimodal analgesia regimen for colorectal surgery. CWI can reduce morphine consumption without increasing adverse effects.
这项前瞻性双盲随机临床试验的目的是确定在结直肠手术的剖腹手术或电视辅助腹腔镜检查后，局部麻醉药罗哌卡因的腹膜前持续伤口灌注（CWI）是否会减少患者吗啡的用量。
计划进行结直肠手术的患者在剖腹手术后以5毫升/小时的速率或在腹腔镜检查后以2毫升/小时的速率随机接受48小时的腹膜前0.38%罗哌卡因或0.9%生理盐水的CWI。主要终点是手术期间及之后通过患者自控镇痛装置的吗啡总用量。还比较了剖腹手术和腹腔镜检查亚组的结果。
纳入67例患者，罗哌卡因CWI组33例，生理盐水组34例。罗哌卡因组的吗啡用量中位数[四分位间距（IQR）][23.5毫克（11.25 - 42.75）]低于生理盐水组[52毫克（24.5 - 64）]（P = 0.010）。接受罗哌卡因的剖腹手术亚组的吗啡用量[21.5（15.6 - 34.7）]也低于生理盐水组[52.5（22.5 - 65）毫升]（P = 0.041）。接受罗哌卡因或生理盐水的腹腔镜检查患者的用量在统计学上相似。未观察到副作用。16例患者发生手术伤口感染（23.9%）；11例（16.4%）出现伤口感染，5例（7.5%）出现器官间隙感染。共获得46份导管培养物；10份（21.7%）为阳性，评估为污染所致。
罗哌卡因的腹膜前CWI是结直肠手术多模式镇痛方案中一种良好且安全的补充方法。CWI可减少吗啡用量而不增加不良反应。
