Speciality Doctor in Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, UK.
Core Trainee in Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, UK.
Scand J Pain. 2020 Oct 25;20(4):847-851. doi: 10.1515/sjpain-2020-0034.
Background Open radical nephrectomy and inferior vena cava exploration through a roof top incision involves significant peri-operative morbidity including severe postoperative pain. Although thoracic epidural analgesia provides excellent pain relief, recent trends suggest search for effective alternatives. Systemic morphine is often used as an alternative analgesic technique. However, it does not provide dynamic analgesia and can often impede recovery in patients undergoing major surgery on the abdomen. The authors present the first report of a novel analgesic regimen in this cohort with good outcomes. Methods Five patients undergoing open radical nephrectomy and inferior vena cava exploration received erector spinae plane infusion and intra thecal opioid analgesia at a tertiary care university teaching hospital. Outcomes included dynamic analgesia, length of hospital stay and complications Results Five adult patients undergoing major upper abdominal surgery, who refused thoracic epidural analgesia, received erector spinae plane infusion and intrathecal opioid analgesia. Patients reported effective dynamic analgesia, minimal use of rescue analgesia, early ambulation and enhanced recovery. Conclusion The novel regimen that avoids both epidural analgesia and systemic morphine can be an option in enabling enhanced recovery in this cohort.
背景 经屋顶切口行开放性根治性肾切除术和下腔静脉探查术涉及到重大围手术期发病率，包括严重的术后疼痛。尽管胸硬膜外镇痛可提供出色的止痛效果，但最近的趋势表明需要寻找有效的替代方法。全身吗啡通常被用作替代镇痛技术。然而，它不能提供动态镇痛，并且在腹部接受重大手术的患者中经常会阻碍恢复。作者在该队列中首次报告了一种新的镇痛方案，效果良好。 方法 在一家三级护理大学教学医院，五名接受开放性根治性肾切除术和下腔静脉探查术的患者接受了竖脊肌平面输注和鞘内阿片类药物镇痛。结果 五名接受大型上腹部手术的成年患者拒绝接受胸硬膜外镇痛，接受了竖脊肌平面输注和鞘内阿片类药物镇痛。患者报告了有效的动态镇痛，很少需要抢救性镇痛，早期活动和快速康复。结论 这种避免使用硬膜外镇痛和全身吗啡的新方案可作为促进该队列快速康复的选择。
