在结直肠手术的加速康复外科方案中，口服与静脉给予对乙酰氨基酚的比较。

Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery.

机构信息

Department of General Surgery, Cooper University Hospital, Camden, NJ.

Department of Anesthesiology, Cooper University Hospital, Camden, NJ.

出版信息

Pain Physician. 2020 Jan;23(1):57-64.

PMID:32013279

Abstract

BACKGROUND

Multimodal pain management within enhanced recovery after surgery (ERAS) protocols is designed to decrease opioid use, promote mobilization, and decrease postoperative complications.

OBJECTIVES

To evaluate the role of intravenous (IV) versus oral (PO) acetaminophen within an established ERAS protocol in colorectal surgery.

STUDY DESIGN

This was a retrospective observational study.

SETTING

This research took place within an established perioperative colorectal surgery protocol.

METHODS

A total of 91 consecutive elective colorectal resections performed according to an ERAS protocol using only IV acetaminophen (IV group) were compared with 84 consecutive resections performed using one dose of IV acetaminophen followed by subsequent administration of oral acetaminophen (PO group). Our multimodal pain management strategy also included transverse abdominis plane blocks, celecoxib, and ketorolac medications for both groups. Opioid requirements, maximum and average daily pain scores by the Visual Analog Scale, and postoperative outcomes were compared between groups.

RESULTS

There were no differences in maximum or average pain scores on postoperative days 0-3 or at time of discharge between IV and PO groups. Compared with the IV acetaminophen only group, the PO group received significantly more perioperative opioids through 72 hours postoperatively (68.8 oral morphine equivalents [OME] IV group vs. 93.7 OME PO group; P < 0.0001), were more likely to require opioid patient-controlled analgesia (8.9% IV group vs. 46.4% PO group; P < 0.0001), and were more likely to experience postoperative nausea and vomiting (33.0% IV group vs. 48.8% PO group; P = 0.0449).

LIMITATIONS

Significant limitations include the studies' retrospective nature and that it was performed at a single institution.

CONCLUSIONS

Restriction of IV acetaminophen within an ERAS protocol in colorectal surgery was associated with increased opioid use, greater need for opioid patient-controlled analgesia, and increased incidence of postoperative nausea and vomiting. IV acetaminophen may be superior to oral acetaminophen in the early postoperative setting.

KEY WORDS

Perioperative pain management, enhanced recovery after surgery, acetaminophen, multimodal pain control, nonopioid.

摘要

背景

围手术期强化康复（ERAS）方案中的多模式疼痛管理旨在减少阿片类药物的使用、促进活动和减少术后并发症。

目的

评估在既定 ERAS 方案中静脉（IV）与口服（PO）对乙酰氨基酚在结直肠手术中的作用。

研究设计

这是一项回顾性观察性研究。

设置

本研究在既定的围手术期结直肠手术方案中进行。

方法

将 91 例连续行 ERAS 方案的择期结直肠切除术（仅使用 IV 对乙酰氨基酚的 IV 组）与 84 例连续行 ERAS 方案的 IV 对乙酰氨基酚单次给药后再给予口服对乙酰氨基酚的切除术（PO 组）进行比较。我们的多模式疼痛管理策略还包括两组的腹横肌平面阻滞、塞来昔布和酮咯酸。比较两组之间的阿片类药物需求、术后 0-3 天的最大和平均每日疼痛评分以及术后结局。

结果

IV 组和 PO 组在术后 0-3 天或出院时的最大或平均疼痛评分无差异。与仅用 IV 对乙酰氨基酚的组相比，PO 组在术后 72 小时内接受了更多的围手术期阿片类药物（68.8 口服吗啡等效物 [OME] IV 组与 93.7 OME PO 组；P<0.0001），更有可能需要阿片类药物患者自控镇痛（8.9% IV 组与 46.4% PO 组；P<0.0001），并且更有可能出现术后恶心和呕吐（33.0% IV 组与 48.8% PO 组；P=0.0449）。