Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham, NHS Foundation Trust, B15 2TH, UK.
Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham, NHS Foundation Trust, B15 2TH, UK.
HPB (Oxford). 2019 Aug;21(8):945-952. doi: 10.1016/j.hpb.2019.02.007. Epub 2019 Mar 14.
Although epidural analgesia (EA) provides effective pain control after open hepatectomy, postoperative hypotension is a common problem that limits ambulation. There is growing interest in alternative methods of pain control after open abdominal surgery, including a potential role for local anaesthetic infusion via wound catheter (WC). The aim of this study was to evaluate the available evidence for WC in open hepatectomy by conducting a meta-analysis of randomised trials.
A systematic database search of literature published in the last 20 years was performed. Only randomised controlled trials (RCTs) were included in the study. Meta-analyses were performed using both fixed-effects and random-effects models.
WC patients had significantly faster functional recovery (WMD = -0.73 (-1.13, -0.32), I = 0%, p = 0.004). There was no significant difference in pain scores on the first postoperative day (POD1). On POD2, WC patients had higher pain scores compared to EA patients (WMD = 0.29 (0.09, 0.49), I = 0%, p < 0.004), but this corresponded with significantly lower opioid consumption in WC patients (WMD = -6.29 (-7.92, -4.65), I = 62%, p < 0.001). There was no significant difference in major hepatectomy, incision length, complications, length of hospital stay or readmissions between groups.
Despite higher pain scores on the second postoperative day, functional recovery after open hepatectomy is faster in patients with wound catheters compared with epidural analgesia. Wound catheters should be considered the preferred mode of analgesia after open hepatectomy.
虽然硬膜外镇痛（EA）可在开腹肝切除术后提供有效的疼痛控制，但术后低血压是限制活动的常见问题。对于开腹手术后的替代疼痛控制方法，包括通过伤口导管（WC）局部麻醉剂输注的潜在作用，人们越来越感兴趣。本研究的目的是通过对随机试验的荟萃分析来评估开腹肝切除术后 WC 的现有证据。
对过去 20 年发表的文献进行系统的数据库搜索。仅纳入研究中的随机对照试验（RCT）。使用固定效应和随机效应模型进行荟萃分析。
WC 患者的功能恢复更快（WMD=-0.73[-1.13，-0.32]，I=0%，p=0.004）。术后第 1 天（POD1）的疼痛评分无显著差异。在 POD2，WC 患者的疼痛评分高于 EA 患者（WMD=0.29[0.09，0.49]，I=0%，p<0.004），但 WC 患者的阿片类药物消耗量明显较低（WMD=-6.29[-7.92，-4.65]，I=62%，p<0.001）。两组之间在主要肝切除术、切口长度、并发症、住院时间或再入院率方面无显著差异。
尽管术后第 2 天疼痛评分较高，但与硬膜外镇痛相比，WC 患者开腹肝切除术后的功能恢复更快。WC 应被视为开腹肝切除术后的首选镇痛方式。
