Niewiński Grzegorz, Figiel Wojciech, Grąt Michał, Dec Marta, Morawski Marcin, Patkowski Waldemar, Zieniewicz Krzysztof
Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097, Warsaw, Poland.
World J Surg. 2020 Jul;44(7):2340-2349. doi: 10.1007/s00268-020-05437-x.
Effective analgesia is essential for patient recovery after liver resection. This study aimed to evaluate the effects of the addition of preoperative intrathecal morphine to multimodal intravenous analgesia in patients undergoing liver resection.
In this single-blind randomized controlled trial, patients undergoing liver resection were randomly assigned to the patient-controlled analgesia with (ITM-IV) or without (IV) preoperative intrathecal morphine groups. All patients received acetaminophen and dexketoprofen. The primary outcome was pain severity at rest over three postoperative days, assessed using the numerical rating scale (NRS).
The study included 36 patients (18 in each group). The mean maximum daily NRS scores over the first three postoperative days in the ITM-IV and IV groups were 1.3, 1.1, and 0.3 and 1.6, 1.1, and 0.7, respectively (p = 0.580). No differences were observed in pain severity while coughing, with corresponding scores of 2.8, 2.1, and 1.1, respectively, in the ITM-IV group and 2.3, 2.2, and 1.5, respectively, in the IV group (p = 0.963). Proportions of patients reporting clinically significant pain at rest and while coughing were 11.1% and 44.4%, respectively, in the ITM-IV group, and 16.7% and 44.4%, respectively, in the IV group (both p > 0.999). Cumulative morphine doses in the ITM-IV and IV groups were 26 mg and 17 mg, respectively (p = 0.257). Both groups also showed similar time to mobilization (p = 0.791) and solid food intake (p = 0.743), sedation grade (p = 0.584), and morbidity (p = 0.402).
Preoperative intrathecal morphine administration provides no benefits to multimodal analgesia in patients undergoing liver resection.
Clinicaltrial.gov Identifier: NCT03620916.
有效的镇痛对于肝切除术后患者的恢复至关重要。本研究旨在评估术前鞘内注射吗啡联合多模式静脉镇痛对肝切除患者的影响。
在这项单盲随机对照试验中，将接受肝切除术的患者随机分为术前鞘内注射吗啡的患者自控镇痛组（ITM-IV）和未注射组（IV）。所有患者均接受对乙酰氨基酚和右酮洛芬。主要结局是术后三天静息时的疼痛严重程度，采用数字评分量表（NRS）进行评估。
该研究纳入了36例患者（每组18例）。ITM-IV组和IV组术后前三天的每日平均最大NRS评分分别为1.3、1.1和0.3以及1.6、1.1和0.7（p = 0.580）。咳嗽时的疼痛严重程度无差异，ITM-IV组相应评分分别为2.8、2.1和1.1，IV组分别为2.3、2.2和1.5（p = 0.963）。ITM-IV组静息和咳嗽时报告有临床显著疼痛的患者比例分别为11.1%和44.4%，IV组分别为16.7%和44.4%（p均>0.999）。ITM-IV组和IV组的吗啡累积剂量分别为26 mg和17 mg（p = 0.257）。两组在活动时间（p = 0.791）、固体食物摄入时间（p = 0.743）、镇静分级（p = 0.584）和发病率（p = 0.402）方面也相似。
术前鞘内注射吗啡对肝切除患者的多模式镇痛无益处。
Clinicaltrial.gov标识符：NCT03620916。
