Radovanović Dragana, Radovanović Zoran, Škorić-Jokić Svetlana, Tatić Milanka, Mandić Aljoša, Ivković-Kapicl Tatjana
School of Medicine, University of Novi Sad, Novi Sad; Department of Anesthesiology and Intensive Care.
School of Medicine, University of Novi Sad, Novi Sad; Department of Surgical Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.
Acta Clin Croat. 2017 Jun;56(2):244-254. doi: 10.20471/acc.2017.56.02.07.
The aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. This prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. The secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side effects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p<0.001) and resumption of dietary intake was achieved earlier (p<0.001) in TEA group. Intensity of pain during the first 3 postoperative days was significantly lower at rest, on coughing and during mobilization (p<0.001), and mobilization was much more effi cient (p<0.005) in TEA than in IV-PCA group. Satisfaction scores were better in TEA group (p<0.001). Nausea, sedation and postoperative delirium occurred less frequently in TEA group (p<0.05, p<0.001 and p<0.05, respectively). TEA demonstrated significantly better effectiveness than IV-PCA after open colorectal cancer surgery and had a positive impact on bowel function, dietary intake, patient satisfaction and early mobilization. The results of this study demonstrated the importance of implementation of TEA as a preferred method for postoperative pain control after major open colorectal surgery.
本研究旨在比较开放性结直肠癌手术后胸段硬膜外镇痛（TEA）和静脉自控镇痛（IV-PCA）的效果。这项前瞻性研究纳入了60例计划接受择期开放性结直肠癌手术的患者，随机分为术后静脉注射吗啡自控镇痛组（n = 30）和左旋布比卡因、芬太尼及肾上腺素混合液胸段硬膜外镇痛组（n = 30）。主要结局指标为肠功能恢复情况。次要结局指标为静息、咳嗽及活动时的术后镇痛质量。中间结局指标包括患者满意度、下床时间、副作用发生率和术后并发症以及出院时间。TEA组术后肠梗阻恢复更快（p<0.001），饮食摄入恢复更早（p<0.001）。术后前3天，TEA组静息、咳嗽及活动时的疼痛强度显著更低（p<0.001），且活动效果在TEA组比IV-PCA组更佳（p<0.005）。TEA组的满意度评分更高（p<0.001）。TEA组恶心、镇静及术后谵妄的发生率更低（分别为p<0.05、p<0.001和p<0.05）。开放性结直肠癌手术后，TEA的有效性显著优于IV-PCA，且对肠功能、饮食摄入、患者满意度及早期活动有积极影响。本研究结果表明，在开放性结直肠癌大手术后，采用TEA作为术后疼痛控制的首选方法具有重要意义。
