Naito Masanori, Sato Takeo, Nakamura Takatoshi, Yamanashi Takahiro, Miura Hirohisa, Tsutsui Atsuko, Watanabe Masahiko
Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan.
Ann Med Surg (Lond). 2017 Mar 29;17:38-42. doi: 10.1016/j.amsu.2017.03.033. eCollection 2017 May.
The main advantage of laparoscopic surgery is that it is minimally invasive because of the use of small incisions. An approach using small incisions offers many benefits including attenuation of surgical wound pain. However, the presence of postoperative pain may undermine the advantages of laparoscopic surgery as a minimally invasive technique. In addition, perioperative pain management is an important factor affecting recovery after surgery. This study investigated the usefulness of a multimodal approach to postoperative pain management with acetaminophen as a baseline analgesic after minimally invasive laparoscopic colorectal surgery.
The study included 40 patients who underwent laparoscopic colorectal surgery for colorectal cancer. 20 patients received acetaminophen as a baseline analgesic for postoperative pain management and 20 received epidural anesthesia.
The urethral catheter could be removed earlier in the acetaminophen group (2.1 ± 0.22 days postoperatively) compared with the epidural group (4.1 ± 0.45days postoperatively). The frequencies of vertigo were significantly lower in the acetaminophen than epidural group (10.0% and 45.0%, respectively). The frequencies of the use of analgesics on an as-needed basis for postoperative pain relief as well as the variabilities in these frequencies, although not significantly different between the acetaminophen and epidural groups, were lower in the acetaminophen group than the epidural group.
We herein demonstrated that postoperative pain management with acetaminophen as a baseline analgesic, and without the use of epidural anesthesia, is a safe and useful analgesic modality.
腹腔镜手术的主要优点是由于使用小切口而具有微创性。采用小切口的手术方式有许多益处,包括减轻手术伤口疼痛。然而,术后疼痛的存在可能会削弱腹腔镜手术作为一种微创技术的优势。此外,围手术期疼痛管理是影响术后恢复的一个重要因素。本研究调查了在微创腹腔镜结直肠手术后,以对乙酰氨基酚作为基础镇痛药的多模式术后疼痛管理方法的有效性。
该研究纳入了40例因结直肠癌接受腹腔镜结直肠手术的患者。20例患者接受对乙酰氨基酚作为术后疼痛管理的基础镇痛药,20例接受硬膜外麻醉。
与硬膜外组(术后4.1±0.45天)相比,对乙酰氨基酚组(术后2.1±0.22天)能更早拔除导尿管。对乙酰氨基酚组眩晕的发生率显著低于硬膜外组(分别为10.0%和45.0%)。尽管对乙酰氨基酚组和硬膜外组在术后按需使用镇痛药缓解疼痛的频率及其变异性方面无显著差异,但对乙酰氨基酚组低于硬膜外组。
我们在此证明,以对乙酰氨基酚作为基础镇痛药且不使用硬膜外麻醉进行术后疼痛管理是一种安全有效的镇痛方式。