Division of Pediatric Anesthesiology, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
Division of Pediatric Anesthesiology, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Reg Anesth Pain Med. 2019 Jan;44(1):123-129. doi: 10.1136/rapm-2018-000017.
Enhanced recovery protocols (ERPs) decrease length of stay and postoperative morbidity, but it is important that these benefits do not come at a cost of sacrificing proper perioperative analgesia. In this retrospective, matched cohort study, we evaluated postoperative pain intensity in pediatric patients who underwent laparoscopic colorectal surgeries before and after ERP implementation.
Patients in each cohort were randomly matched based on age, diagnosis, American Society of Anesthesiologists classification, and surgical procedure. The primary outcome was average daily postoperative pain score, while the secondary outcomes included postoperative hospital length of stay, complication rate, and 30-day readmissions. Since our hypothesis was non-inferior analgesia in the postprotocol cohort, a non-inferiority study design was used.
After matching, 36 pairs of preprotocol and postprotocol patients were evaluated. ERP patients had non-inferior recovery room pain scores (difference 0 (-1.19, 0) points, 95% CI -0.22 to 0.26 points, p value <0.001) and 4-day postoperative pain scores (difference -0.3±1.9 points, 95% CI -0.82 to 0.48 points, p value <0.001) while receiving less postoperative opioids (difference -0.15 [-0.21, -0.05] intravenous morphine equivalents/kg/day, p<0.001). ERP patients also had reduced postoperative hospital stays (difference -1.5 [-4.5, 0] days, p<0.001) and 30-day readmissions (2.8% vs 27.8%, p=0.008).
Implementation of our ERP for pediatric laparoscopic colorectal patients was associated with less perioperative opioids without worsening postoperative pain scores. In addition, patients who received the protocol had faster return of bowel function, shorter postoperative hospital stays, and a lower rate of 30-day hospital readmissions. In pediatric laparoscopic colorectal patients, the incorporation of an ERP was associated with a pronounced decrease in perioperative morbidity without sacrificing postoperative analgesia.
加速康复方案（ERPs）可缩短住院时间和减少术后发病率，但重要的是，这些益处不应以牺牲适当的围手术期镇痛为代价。在这项回顾性、匹配队列研究中，我们评估了在实施 ERP 前后接受腹腔镜结直肠手术的儿科患者的术后疼痛强度。
根据年龄、诊断、美国麻醉医师协会分类和手术程序，对每个队列中的患者进行随机匹配。主要结局是平均每日术后疼痛评分，次要结局包括术后住院时间、并发症发生率和 30 天再入院率。由于我们的假设是在方案后队列中具有非劣效的镇痛效果，因此采用了非劣效性研究设计。
匹配后，评估了 36 对方案前和方案后的患者。ERP 患者在恢复室疼痛评分（差异 0（-1.19，0）点，95%CI-0.22 至 0.26 点，p 值<0.001）和 4 天术后疼痛评分（差异-0.3±1.9 点，95%CI-0.82 至 0.48 点，p 值<0.001）方面具有非劣效性，同时接受的术后阿片类药物较少（差异-0.15[-0.21，-0.05]静脉吗啡等效物/kg/天，p<0.001）。ERP 患者的术后住院时间（差异-1.5[-4.5，0]天，p<0.001）和 30 天再入院率（2.8%对 27.8%，p=0.008）也有所降低。
在小儿腹腔镜结直肠患者中实施我们的 ERP 方案与减少围手术期阿片类药物的使用而不恶化术后疼痛评分相关。此外，接受该方案的患者术后肠功能恢复更快，住院时间更短，30 天内再入院率更低。在小儿腹腔镜结直肠患者中，ERP 的实施与明显降低围手术期发病率而不牺牲术后镇痛相关。
