Sztain Jacklynn F, Gabriel Rodney A, Said Engy T
Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA.
Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA.
J Cardiothorac Vasc Anesth. 2019 Mar;33(3):694-698. doi: 10.1053/j.jvca.2018.06.013. Epub 2018 Jun 23.
Thoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control in thoracic surgery, however it is associated with the undesirable risks of hypotension urinary retention, and bleeding. Recently, surgical site infiltration with liposomal bupivicaine (LB) has been suggested as a comparable alternative to TEA. The authors compared total opioid consumption in patients who received either TEA or LB undergoing video-assisted thorascopic surgery (VATS) for lobectomy.
Retrospective cohort study.
University hospital.
Patients undergoing VATS for lobectomy.
TEA versus LB MEASUREMENTS AND MAIN RESULTS: The primary outcome was POD 0 to 2 total opioid requirements, measured in intravenous morphine equivalents (mg). Wilcoxon rank sum test was used to calculate the significant differences in the primary outcome. The 25 - 75% interquartile range (IQR) was reported with each median value. Forty-five patients were included in the analysis, in which 14 (31.1%) were in the LB group. Between the TEA and LB group, there were no differences in age, sex, or body mass. The median (25 - 75% IQR) total opioid consumption during POD 0 - 2 in the TEA and LB group were 28.0 mg (12.0 - 52.0 mg) and 49.5 mg (35.0 - 70.5 mg), respectively (p = 0.03), in which the median difference was 22.5 mg (95% CI 0.60 - 38.0 mg).
VATs lobectomy patients consumed 43.4% less opioids on POD 0-2 with TEA when compared to surgical site infiltration of LB. Further prospective randomized controlled trials are required to demonstrate superior analgesia of TEA in this surgical population.
胸段硬膜外镇痛（TEA）被认为是胸外科手术后疼痛控制的金标准，然而它与低血压、尿潴留和出血等不良风险相关。最近，有人提出脂质体布比卡因（LB）手术部位浸润可作为TEA的一种可比替代方法。作者比较了接受TEA或LB的电视辅助胸腔镜手术（VATS）肺叶切除术患者的总阿片类药物消耗量。
回顾性队列研究。
大学医院。
接受VATS肺叶切除术的患者。
TEA与LB
主要结局是术后第0至2天的总阿片类药物需求量，以静脉注射吗啡当量（mg）衡量。采用Wilcoxon秩和检验计算主要结局的显著差异。每个中位数均报告25 - 75%四分位数间距（IQR）。45例患者纳入分析，其中14例（31.1%）在LB组。TEA组和LB组在年龄、性别或体重方面无差异。TEA组和LB组术后第0 - 2天的总阿片类药物消耗量中位数（25 - 75% IQR）分别为28.0 mg（12.0 - 52.0 mg）和49.5 mg（35.0 - 70.5 mg）（p = 0.03），中位数差异为22.5 mg（95% CI 0.60 - 38.0 mg）。
与LB手术部位浸润相比，VATS肺叶切除术患者在术后第0 - 2天接受TEA时阿片类药物消耗量减少43.4%。需要进一步的前瞻性随机对照试验来证明TEA在该手术人群中的镇痛效果更优。
