Romnek Mary J, Diefenbach Karen, Tumin Dmitry, Tobias Joseph D, Kim Stephani, Thung Arlyne
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
J Laparoendosc Adv Surg Tech A. 2020 May;30(5):590-595. doi: 10.1089/lap.2019.0510. Epub 2020 Apr 8.
Minimally invasive surgical (MIS) approaches for thoracic procedures in adults result in an improved postoperative course with less pain, but there are limited data on similar procedures in neonates. We aimed to evaluate postoperative opioid consumption and pain management practices in neonates and infants following MIS versus open repair of congenital diaphragmatic hernia (CDH). This was an IRB approved, retrospective study from 2012 to 2016. Demographic data, intraoperative analgesic regimen, total 7-day postoperative opioid consumption, and use of adjunctive pain medications were compared by surgery type (open versus MIS). Secondary measures included time to tracheal extubation, oral feeds, and discharge home. The study cohort included 28 patients (13 female, median age 5 days, average gestational age 39 weeks, and weight 3 kg). MIS was performed in 8 patients. In the first 7 postoperative days, the median postoperative opioid consumption was 0.3 mg/kg of oral morphine equivalents (interquartile range [IQR] 0.2, 18.3) in the MIS group versus 32.3 mg/kg (IQR 9.9, 53.6) in the open group (95% CI of differences in medians: 8.2-42.9; = .006). No difference was noted in intraoperative opioid administration. Among secondary outcomes, length of stay was significantly longer in the open group. Although several factors may impact the hospital course of neonates with CDH, we found that patients had a more than 100-fold difference in median opioid consumption following repair with MIS versus an open approach. The study also noted significant variation in analgesic regimens suggesting other avenues for improved care of postsurgical neonates.
成人胸部手术的微创外科（MIS）方法可改善术后病程，减轻疼痛，但关于新生儿类似手术的数据有限。我们旨在评估新生儿和婴儿在接受MIS与开放性先天性膈疝（CDH）修复术后的阿片类药物消耗量及疼痛管理措施。这是一项经机构审查委员会批准的2012年至2016年的回顾性研究。通过手术类型（开放手术与MIS）比较人口统计学数据、术中镇痛方案、术后7天阿片类药物总消耗量以及辅助性止痛药物的使用情况。次要指标包括气管拔管时间、经口喂养时间和出院时间。研究队列包括28例患者（13例女性，中位年龄5天，平均胎龄39周，体重3千克）。8例患者接受了MIS手术。在术后的前7天，MIS组术后阿片类药物中位消耗量为0.3毫克/千克口服吗啡当量（四分位间距[IQR]为0.2，18.3），而开放手术组为32.3毫克/千克（IQR为9.9，53.6）（中位数差异的95%置信区间：8.2 - 42.9；P = 0.006）。术中阿片类药物给药量无差异。在次要结局中，开放手术组的住院时间明显更长。尽管有几个因素可能影响CDH新生儿的住院病程，但我们发现，与开放手术相比，MIS修复术后患者的阿片类药物中位消耗量相差100多倍。该研究还指出镇痛方案存在显著差异，这表明在改善术后新生儿护理方面还有其他途径。
