Zhang Wei, Li Ka, Zhang Weihan, Liu Fei, Liu Kai, Song Xiaohai, Chen Xinzu, Yang Kun, Hu Jiankun
Department of Gastrointestinal Surgery, Institute of Gastric Cancer, West China Hospital, Sichuan University, Chengdu 610014, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610014, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Mar 25;20(3):270-276.
To compare the postoperative analgesia efficacy, rehabilitation parameters and complication between multimodal analgesia and traditional analgesia after radical gastrectomy for gastric cancer patients.
Patients with gastric cancer who underwent surgery in our hospital from October 2016 to December 2016 were enrolled in this prospective study. According to the non-randomized method, patients were assigned to multimodal analgesia group(n=32) and traditional analgesia group(n=33) in gastric cancer treatment team A and B in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. The treatment measures of group A were as follows: (1) The ratio of 1/1 diluted ropivacaine (100 mg, 10 ml) was infiltrated around the incision before abdomen closure, with incision sutured layer by layer. (2) Parecoxib sodium (40 mg) was injected intravenously every 12 hours after operation for 5 days. (3) Oxycodone-acetaminophen tablet was given orally on the first day or the second day after operation, 50 mg twice a day. (4) Patient-controlled analgesia was not used after operation. Patients in group B received direct suture of incision and patient-controlled analgesia. The pain score, postoperative rehabilitation and 30-day postoperative complications were collected and analyzed.
Multimodal analgesia group had lower pain scores at 1 d (4.8±0.9), 2 d (4.3±1.0), 3 d (2.9±0.8), 4 d (2.4±0.7) and 5 d (1.7±0.7) after surgery, as compared to traditional analgesia group (5.9±0.9, P=0.000), (5.1±0.7, P=0.001), (3.9±0.8, P=0.000), (3.0±0.6, P=0.000), (2.6±0.7, P=0.000), with significant difference. Postoperative hospital stay [(8.2±1.6) days vs. (10.6±2.2) days, P=0.000], time to ambulation [(47.5±13.8) days vs. (66.2±16.8) days, P=0.000], time to first flatus [(76.4±25.2) days vs. (120.0±29.9) days, P=0.000], time to first defecate [(117.3±42.2) days vs. (159.7±30.7) days, P=0.000] and time to first fluid diet [(83.8±21.6) days vs. (141.9±33.9) days, P=0.000] in the multimodal analgesia group were significantly shorter than those in the traditional analgesia group. There was no significant difference between the two groups with respect to 30-day postoperative complication rate(9.4% vs. 9.1%, P=1.000).
Multimodal analgesia can significantly reduce the postoperative pain and is beneficial to rehabilitation, meanwhile it does not increase the risk of postoperative complications. Multimodal analgesia is safe and effective for gastric cancer patients undergoing radical gastrectomy.
比较多模式镇痛与传统镇痛用于胃癌患者根治性胃切除术后的镇痛效果、康复指标及并发症情况。
选取2016年10月至2016年12月在我院行手术治疗的胃癌患者纳入本前瞻性研究。按照非随机方法，将患者分配至四川大学华西医院胃肠外科A、B两个胃癌治疗小组的多模式镇痛组（n = 32）和传统镇痛组（n = 33）。A组治疗措施如下：（1）在关腹前将1/1稀释的罗哌卡因（100 mg，10 ml）在切口周围浸润，逐层缝合切口。（2）术后每12小时静脉注射帕瑞昔布钠（40 mg），共5天。（3）术后第1天或第2天口服氨酚羟考酮片，50 mg，每日2次。（4）术后不使用患者自控镇痛。B组患者接受切口直接缝合及患者自控镇痛。收集并分析疼痛评分、术后康复情况及术后30天并发症。
与传统镇痛组相比，多模式镇痛组术后1天（4.8±0.9 比5.9±0.9，P = 0.000）、2天（4.3±1.0比5.1±0.7，P = 0.001）、3天（2.9±0.8比3.9±0.8，P = 0.000）、4天（2.4±0.7比3.0±0.6 , P = 0.000）及5天（1.7±0.7比2.6±0.7，P = 0.000）的疼痛评分更低，差异有统计学意义。多模式镇痛组的术后住院时间[（8.2±1.6）天比（10.6±2.2）天，P = 0.000]、下床活动时间[（47.5±13.8）天比（66.2±16.8）天，P = 0.000]、首次排气时间[（76.4±25.2）天比（120.0±29.9）天，P = 0.000]、首次排便时间[（117.3±42.2）天比（159.7±30.7）天，P = 0.000]及首次进流食时间[（83.8±21.6）天比（141.9±33.9）天，P = 0.000]均显著短于传统镇痛组。两组术后30天并发症发生率无显著差异（9.4%比9.1%，P = 1.000）。
多模式镇痛可显著减轻术后疼痛，有利于康复，同时不增加术后并发症风险。多模式镇痛用于胃癌根治性切除术患者安全有效。
