Wang Liping, Li Xuan, Chen Hong, Liang Jie, Wang Yu
Department of Anaesthesiology, Harbin Medical University Cancer Hospital, Harbin, China,
J Pain Res. 2018 Sep 5;11:1743-1749. doi: 10.2147/JPR.S168892. eCollection 2018.
Effective postoperative analgesia is essential for rehabilitation after surgery. Many studies have compared different methods of postoperative pain management for open abdominal surgery. However, the conclusions were inconsistent and controversial. In addition, few studies have focused on gastric cancer (GC) resection. This study aimed to determine the effects of patient-controlled epidural analgesia (PCEA) on postoperative pain management and short-term recovery after GC resection compared with those of patient-controlled intravenous analgesia (PCIA).
We analyzed retrospectively collected data on patients with non-metastatic GC diagnosed between 2010 and 2015 who underwent resection in a university hospital. PCIA and PCEA documented by the acute pain service team were retrospectively analyzed. A propensity score-matched analysis that incorporated preoperative variables was used to compare the short-term outcomes between the PCIA and PCEA groups.
In total, 3,042 patients were identified for analysis. Propensity score matching resulted in 917 patients in each group. The PCEA group exhibited lower pain scores in the recovery room and on the first and second postoperative days (=0.0005, =0.0065, and =0.0034 respectively). The time to the first passage of flatus after surgery was shorter in the PCEA group than in the PCIA group (=0.032). The length of the hospital stay was 12.6±7.2 and 11.8±6.6 days in the PCEA and PCIA groups, respectively. No significant differences were observed in the length of hospital stay or the incidence of complications after surgery.
PCEA provided more effective postoperative pain management and a shorter time to the first passage of flatus than PCIA after GC resection. However, it did not have an effect on the length of hospital stay or the incidence of postoperative complications.
有效的术后镇痛对于手术后的康复至关重要。许多研究比较了开腹手术术后疼痛管理的不同方法。然而，结论并不一致且存在争议。此外，很少有研究关注胃癌（GC）切除术。本研究旨在确定与患者自控静脉镇痛（PCIA）相比，患者自控硬膜外镇痛（PCEA）对GC切除术后疼痛管理和短期恢复的影响。
我们回顾性分析了2010年至2015年间在一家大学医院接受手术切除的非转移性GC患者的数据。对急性疼痛服务团队记录的PCIA和PCEA进行回顾性分析。采用纳入术前变量的倾向评分匹配分析来比较PCIA组和PCEA组的短期结局。
总共确定了3042例患者进行分析。倾向评分匹配后每组有917例患者。PCEA组在恢复室以及术后第1天和第2天的疼痛评分较低（分别为P = 0.0005、P = 0.0065和P = 0.0034）。PCEA组术后首次排气时间比PCIA组短（P = 0.032）。PCEA组和PCIA组的住院时间分别为12.6±7.2天和11.8±6.6天。在住院时间或术后并发症发生率方面未观察到显著差异。
与PCIA相比，PCEA在GC切除术后提供了更有效的术后疼痛管理，且首次排气时间更短。然而，它对住院时间或术后并发症发生率没有影响。
