快速康复腹腔镜减肥手术的围手术期镇痛
Perioperative Analgesia for Fast-Track Laparoscopic Bariatric Surgery.
作者信息
Bamgbade Olumuyiwa A, Oluwole Oluwafemi, Khaw Rong R
机构信息
Department of Anaesthesia, University of British Columbia, Vancouver, BC, Canada.
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.
出版信息
Obes Surg. 2017 Jul;27(7):1828-1834. doi: 10.1007/s11695-017-2562-4.
BACKGROUND
Postoperative pain and analgesia present challenges in bariatric surgery patients. Multimodal analgesia may provide better efficacy, less complications and expedite fast-track bariatric surgical care. There are no studies of the broader topic of perioperative analgesia and the overall impact. This study highlights the impact of multimodal intraoperative analgesia on fast-track bariatric surgery.
METHODS
This observational study examined the perioperative outcome data of 412 consecutive laparoscopic bariatric surgery patients over a 6-year period. Perioperative outcome and variables were analysed and compared between different intraoperative analgesia types.
RESULTS
Mean BMI was 49, mean age was 42 and male:female ratio was 1:4. About 82% of patients received multimodal intraoperative analgesia, comprising various combinations of bupivacaine infiltration and intravenous acetaminophen, morphine, tramadol, parecoxib or diclofenac. Morphine was administered in 83% of patients and tramadol in 17%. Multimodal intraoperative analgesia provided better postoperative analgesia, shorter postanaesthesia care unit (PACU) duration, lower postoperative opioid requirement, less postoperative vomiting, earlier postoperative oral intake, earlier ambulation and shorter hospital stay compared to unimodal intraoperative morphine analgesia (p = 0.0001). Multimodal analgesia comprising tramadol + acetaminophen + diclofenac provided better postoperative analgesia, shorter PACU duration, lower postoperative opioid requirement, earlier ambulation, shorter hospital stay and less postoperative hypopnoea compared to patients who received morphine (p = 0.0001).
CONCLUSIONS
Multimodal intraoperative analgesia provides better postoperative analgesia, less complications and better perioperative outcomes and facilitates fast-track bariatric surgical care. Tramadol is suitable, efficacious and safe and associated with the best perioperative outcomes in bariatric surgery patients.
背景
肥胖症手术患者的术后疼痛及镇痛是一大挑战。多模式镇痛可能具有更好的疗效、更少的并发症，并能加快肥胖症手术的快速康复护理进程。目前尚无关于围手术期镇痛这一更广泛主题及其整体影响的研究。本研究着重探讨多模式术中镇痛对肥胖症快速康复手术的影响。
方法
本观察性研究对连续412例接受腹腔镜肥胖症手术患者在6年期间的围手术期结局数据进行了分析。对不同术中镇痛类型的围手术期结局及变量进行了分析和比较。
结果
平均体重指数为49，平均年龄为42岁，男女比例为1:4。约82%的患者接受了多模式术中镇痛，包括布比卡因浸润与静脉注射对乙酰氨基酚、吗啡、曲马多、帕瑞昔布或双氯芬酸的各种组合。83%的患者使用了吗啡，17%的患者使用了曲马多。与单模式术中吗啡镇痛相比，多模式术中镇痛提供了更好的术后镇痛效果、更短的麻醉后恢复室（PACU）停留时间、更低的术后阿片类药物需求量、更少的术后呕吐、更早的术后经口进食、更早的下床活动及更短的住院时间（p = 0.0001）。与接受吗啡的患者相比，曲马多+对乙酰氨基酚+双氯芬酸组成的多模式镇痛提供了更好的术后镇痛效果、更短的PACU停留时间、更低的术后阿片类药物需求量、更早的下床活动、更短的住院时间及更少的术后呼吸浅慢（p = 0.0001）。
结论
多模式术中镇痛可提供更好的术后镇痛效果、更少的并发症及更好的围手术期结局，并有助于肥胖症手术的快速康复护理。曲马多适用于肥胖症手术患者，有效且安全，与最佳的围手术期结局相关。
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