Khansa Ibrahim, Koogler Andrew, Richards Jesse, Bryant Richard, Janis Jeffrey E
Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Plast Reconstr Surg Glob Open. 2017 Jun 23;5(6):e1400. doi: 10.1097/GOX.0000000000001400. eCollection 2017 Jun.
In abdominal wall reconstruction, adequate pain control and minimization of narcotic consumption are essential to improving patient outcomes and satisfaction. Previous studies have examined the role of individual strategies, such as neuraxial analgesia and multimodal analgesia. However, there has not been a study that examined all potential determinants of postoperative narcotic requirements, including intraoperative strategies.
Consecutive patients who underwent abdominal wall reconstruction were reviewed. Preoperative factors (chronic preoperative narcotic usage, indication for abdominal wall reconstruction, administration of neuraxial analgesia), intraoperative factors (intraoperative narcotics administered, method of mesh fixation), and postoperative factors (multimodal analgesia, complications) were collected. The main outcomes were daily amount of opioids used and length of hospital stay.
Ninety-three patients were included in the study. Patients who had an epidural required lower doses of opioids postoperatively, while those on chronic preoperative opioids, those whose mesh was fixated using transfascial sutures, and those who received large doses of opioids intraoperatively required higher doses of postoperative opioids. Hospital length of stay was longer in patients who received transfascially sutured mesh and those on chronic opioids preoperatively.
This study provides potential strategies to improve pain control and minimize narcotic consumption postoperatively in patients undergoing abdominal wall reconstruction. Intraoperative administration of opioids should be minimized to avoid the development of tolerance. Epidural analgesia reduces postoperative narcotic requirement and may be especially beneficial in patients at highest risk for postoperative pain, including those on chronic opioids, and those in whom transfascial sutures are used for mesh fixation.
在腹壁重建手术中，充分的疼痛控制和减少麻醉药物的使用对于改善患者预后和满意度至关重要。既往研究已探讨了诸如神经轴索镇痛和多模式镇痛等个体策略的作用。然而，尚未有研究对术后麻醉药物需求的所有潜在决定因素进行考察，包括术中策略。
对连续接受腹壁重建手术的患者进行回顾性分析。收集术前因素（术前长期使用麻醉药物、腹壁重建的指征、神经轴索镇痛的应用）、术中因素（术中使用的麻醉药物、补片固定方法）和术后因素（多模式镇痛、并发症）。主要结局指标为每日使用的阿片类药物量和住院时间。
93例患者纳入本研究。接受硬膜外麻醉的患者术后所需阿片类药物剂量较低，而术前长期使用阿片类药物的患者、补片采用经筋膜缝合固定的患者以及术中接受大剂量阿片类药物的患者术后所需阿片类药物剂量较高。采用经筋膜缝合补片的患者和术前长期使用阿片类药物的患者住院时间较长。
本研究为改善腹壁重建术后患者的疼痛控制和减少麻醉药物使用提供了潜在策略。应尽量减少术中阿片类药物的使用以避免耐受性的产生。硬膜外镇痛可降低术后麻醉药物需求，对于术后疼痛风险最高的患者可能尤其有益，包括术前长期使用阿片类药物的患者以及补片采用经筋膜缝合固定的患者。
