Turner Taylor B, Habib Ashraf S, Broadwater Gloria, Valea Fidel A, Fleming Nicole D, Ehrisman Jessie A, Di Santo Nicola, Havrilesky Laura J
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Women's Anesthesia Division, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
J Minim Invasive Gynecol. 2015 Sep-Oct;22(6):1004-10. doi: 10.1016/j.jmig.2015.05.003. Epub 2015 May 9.
To retrospectively evaluate perioperative pain and analgesic and antiemetic use in patients who underwent surgical staging for endometrial cancer using traditional versus robotic-assisted laparoscopy.
We identified women in a single institution who underwent minimally hysterectomy for endometrial cancer from 2008 to 2012. Patient characteristics and perioperative outcomes, including analgesic and antiemetic use and pain scores, were analyzed. After univariate analysis, a multivariate linear regression model was generated to determine factors associated with narcotic use in the post anesthesia care unit (PACU) (Canadian Task Force Classification II-3).
A single academic institution in the United States from 2008 to 2012.
Women undergoing total laparoscopic hysterectomy or robotic-assisted laparoscopic hysterectomy for endometrial cancer.
Laparoscopic or robotic-assisted laparoscopic hysterectomy.
Three hundred thirty-five women were included (213 laparoscopy and 122 robotic-assisted laparoscopy). There was no difference in pain scores at 0 to 6 and 6 to 12 hours after surgery; at 12 to 24 hours, robotic-assisted surgery was associated with higher median pain scores (5/10 vs 4/10, p = .012). Robotic-assisted surgery was associated with a longer anesthesia time (289 vs 255 minutes, p < .001), similar antiemetic use (p = .40), and lower narcotic use in the postanesthesia care unit (PACU) (1.3 mg vs 2.5 mg morphine equivalents, p = .003). There was no difference in narcotic use on the postoperative floor (p = .46). In multivariate analysis controlling for age, menopausal status, anesthesia duration, and local anesthetic use, hysterectomy type was not a significant predictor of PACU narcotic use (p = .86).
In a retrospective analysis, a robotic-assisted approach to endometrial cancer was not associated with reduced PACU narcotic or antiemetic use compared with the traditional laparoscopic approach. Twenty-four-hour narcotic and antiemetic use was also not different between the 2 approaches.
回顾性评估采用传统腹腔镜与机器人辅助腹腔镜对子宫内膜癌患者进行手术分期时的围手术期疼痛及镇痛和止吐药物的使用情况。
我们确定了2008年至2012年在单一机构接受子宫内膜癌微创子宫切除术的女性患者。分析患者特征及围手术期结果，包括镇痛和止吐药物的使用情况及疼痛评分。单因素分析后，建立多变量线性回归模型以确定与麻醉后护理单元（PACU）中使用麻醉药物相关的因素（加拿大工作组分类II-3）。
2008年至2012年美国的一家学术机构。
接受全腹腔镜子宫切除术或机器人辅助腹腔镜子宫切除术治疗子宫内膜癌的女性。
腹腔镜或机器人辅助腹腔镜子宫切除术。
共纳入335名女性（213例行腹腔镜手术，122例行机器人辅助腹腔镜手术）。术后0至6小时及6至12小时疼痛评分无差异；术后12至24小时，机器人辅助手术的中位疼痛评分较高（5/10 vs 4/10，p = 0.012）。机器人辅助手术的麻醉时间较长（289分钟 vs 255分钟，p < 0.001），止吐药物使用情况相似（p = 0.40），且麻醉后护理单元（PACU）中的麻醉药物使用量较低（1.3毫克吗啡当量 vs 2.5毫克吗啡当量，p = 0.003）。术后病房的麻醉药物使用无差异（p = 0.46）。在对年龄、绝经状态、麻醉持续时间和局部麻醉药物使用进行多变量分析时，子宫切除术类型不是PACU麻醉药物使用的显著预测因素（p = 0.86）。
在一项回顾性分析中，与传统腹腔镜手术相比，机器人辅助手术治疗子宫内膜癌并未减少PACU中的麻醉药物或止吐药物使用。两种手术方式在24小时的麻醉药物和止吐药物使用方面也无差异。
