Thurm Mascha, Kröger Dahlin Britt-Inger, Winsö Ola, Ljungberg Börje
a Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care , Umeå University , Umeå , Sweden.
b Department of Urology and Andrology , Umeå University , Umeå , Sweden.
Scand J Urol. 2017 Aug;51(4):277-281. doi: 10.1080/21681805.2017.1318300. Epub 2017 May 22.
This study evaluated whether more effective perioperative analgesia can be part of a multimodal approach to minimizing morbidity and improving postoperative management after the open surgical approaches frequently used in the treatment of renal cell carcinoma (RCC). The aim of the study was to determine whether spinal anesthesia with clonidine can enhance postoperative analgesia, speed up mobilization and reduce the length of hospital stay (LOS).
Between 2012 and 2015, 135 patients with RCC were randomized, in addition to general anesthesia, to receive either spinal analgesia with clonidine or epidural analgesia, stratified to surgical technique. Inclusion criteria were American Society of Anesthesiologists (ASA) score of III or less, age over 18 years and no chronic pain medication or cognitive disorders.
The median LOS was 4 days for patients in the spinal group and 6 days in the epidural group (p = 0.001). There were no differences regarding duration of surgery, blood loss, RENAL score, tumor size or complications between the given analgesia methods. A limitation was that different anesthesiologists were responsible for administering spinal or epidural anesthesia, as in a real-world clinical situation.
In this randomized controlled study, spinal analgesia with clonidine was superior to continuous epidural analgesia in patients operated on with open nephrectomy, based on shorter LOS. A shorter LOS in the study group indicates faster mobilization and improved analgesia. Spinal analgesia did not carry more complications than epidural analgesia.
本研究评估了更有效的围手术期镇痛是否可作为多模式方法的一部分，以尽量减少发病率并改善肾细胞癌（RCC）常用开放手术方法后的术后管理。本研究的目的是确定可乐定脊髓麻醉是否能增强术后镇痛效果、加快活动恢复并缩短住院时间（LOS）。
2012年至2015年间，135例RCC患者除接受全身麻醉外，根据手术技术分层，随机接受可乐定脊髓镇痛或硬膜外镇痛。纳入标准为美国麻醉医师协会（ASA）评分III级或更低、年龄超过18岁且无慢性疼痛药物治疗或认知障碍。
脊髓组患者的中位住院时间为4天，硬膜外组为6天（p = 0.001）。给定镇痛方法在手术持续时间、失血量、RENAL评分、肿瘤大小或并发症方面无差异。一个局限性在于，与实际临床情况一样，不同的麻醉医师负责实施脊髓或硬膜外麻醉。
在这项随机对照研究中，基于更短的住院时间，可乐定脊髓镇痛在接受开放性肾切除术的患者中优于持续硬膜外镇痛。研究组更短的住院时间表明活动恢复更快且镇痛效果更佳。脊髓镇痛的并发症并不比硬膜外镇痛更多。
