Wu Yi-Feng, Li Xian-Peng, Yu Ya-Bo, Chen Lei, Jiang Cun-Bing, Li Ding-Yao, Chen Ming-Liang
Yinzhou Hospital, Medical School, Ningbo University, Ningbo, China.
Rev Assoc Med Bras (1992). 2018 Feb;64(2):175-180. doi: 10.1590/1806-9282.64.02.175.
The present study aimed to investigate the analgesic effect and safety of using local incision analgesia to treat acute postoperative pain in patients with hepatocellular carcinoma (HCC).
A cohort of 60 patients undergoing liver cancer resection was randomly divided into three groups (n=20 per group): local incision analgesia (LIA) group, which received local infiltration with ropivacaine combined with a postoperative analgesia pump; intravenous patient-controlled analgesia (PCA) group, which received fentanyl intravenous analgesia postoperatively; and the control group, which received tramadol hydrochloride injection postoperatively according to the NRS scoring system. The postoperative analgesic effect in each group was compared and tumor recurrence (survival) was analyzed using the Kaplan-Meier method.
NRS scores, rate of analgesic usage, ambulation time (h) and intestinal function recovery time (h) were significantly reduced in LIA group compared with the control group at each postoperative time point (6, 12, 24 and 48 hours; p<0.05). Additionally, the NRS scores of LIA patients at 12 hours post-surgery was significantly reduced compared with PCA group (p<0.05), and the occurrence of postoperative adverse events in LIA group was significantly lower than that in PCA group (p<0.05). Survival analysis demonstrated that the mean survival time (tumor recurrence) was significantly increased in LIA group compared with the control group (χ2=4.749; p=0.029).
Local incision analgesia improves the analgesic effect, causes fewer adverse reactions and increases postoperative survival time. Our study demonstrated that local incision analgesia is a safe and effective method of postoperative pain management following hepatectomy.
本研究旨在探讨局部切口镇痛治疗肝细胞癌（HCC）患者术后急性疼痛的镇痛效果及安全性。
将60例行肝癌切除术的患者随机分为三组（每组n = 20）：局部切口镇痛（LIA）组，接受罗哌卡因局部浸润联合术后镇痛泵；静脉自控镇痛（PCA）组，术后接受芬太尼静脉镇痛；对照组，根据NRS评分系统术后接受盐酸曲马多注射。比较每组术后镇痛效果，并采用Kaplan-Meier法分析肿瘤复发（生存）情况。
与对照组相比，LIA组在术后各时间点（6、12、24和48小时）的NRS评分、镇痛药物使用率、下床活动时间（小时）和肠功能恢复时间（小时）均显著降低（p < 0.05）。此外，但与PCA组相比，LIA组患者术后12小时的NRS评分显著降低（p < 0.05），且LIA组术后不良事件的发生率显著低于PCA组（p < 0.05）。生存分析表明，与对照组相比，LIA组的平均生存时间（肿瘤复发）显著延长（χ2 = 4.749；p = 0.029）。
局部切口镇痛可提高镇痛效果，减少不良反应，延长术后生存时间。我们的研究表明，局部切口镇痛是肝切除术后安全有效的术后疼痛管理方法。
