Knaak Cornelia, Spies Claudia, Schneider Alice, Jara Maximilian, Vorderwülbecke Gerald, Kuhlmann Anna Dorothea, von Haefen Clarissa, Lachmann Gunnar, Schulte Erika
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Pain Med. 2020 Nov 1;21(11):2650-2660. doi: 10.1093/pm/pnaa130.
To assess the effects of epidural anesthesia (EA) on patients who underwent liver resection.
Secondary analysis of a prospective randomized controlled trial.
This single-center study was conducted at an academic medical center.
A subset of 110 1:1 propensity score-matched patients who underwent liver resection with and without EA were analyzed. Outcome measures were pain intensity ≥5 on a numeric rating scale (NRS) at rest and during movement on postoperative days 1-5, analyzed with logistic mixed-effects models, and postoperative complications according to the Clavien-Dindo classification, length of hospital stay (LOS), and one-year survival. One-year survival in the matched cohorts was compared using a frailty model.
EA patients were less likely to experience NRS ≥5 at rest (odds ratio = 0.06, 95% confidence interval [CI] = 0.01 to 0.28, P < 0.001). These findings were independent of age, sex, Charlson comorbidity index, baseline NRS, and surgical approach (open vs laparoscopic). The number and severity of postoperative complications and LOS were comparable between groups (P = 0.258, P > 0.999, and P = 0.467, respectively). Reduced mortality rates were seen in the EA group one year after surgery (9.1% vs 30.9%, hazard ratio = 0.32, 95% CI = 0.11 to 0.90, P = 0.031). No EA-related adverse events occurred. Earlier recovery of bowel function was seen in EA patients.
Patients with EA had better postoperative pain control and required fewer systemic opioids. Postoperative complications and LOS did not differ, although one-year survival was significantly improved in patients with EA. EA applied in liver surgery was effective and safe.
评估硬膜外麻醉（EA）对接受肝切除术患者的影响。
一项前瞻性随机对照试验的二次分析。
这项单中心研究在一家学术医疗中心进行。
对110例1:1倾向评分匹配的接受或未接受EA肝切除术的患者进行了分析。结局指标包括术后第1 - 5天静息和活动时数字评分量表（NRS）疼痛强度≥5，采用逻辑混合效应模型进行分析，以及根据Clavien-Dindo分类的术后并发症、住院时间（LOS）和一年生存率。使用脆弱模型比较匹配队列中的一年生存率。
EA患者静息时NRS≥5的可能性较小（比值比 = 0.06，95%置信区间[CI] = 0.01至0.28，P < 0.001）。这些发现与年龄、性别、Charlson合并症指数、基线NRS和手术方式（开放手术与腹腔镜手术）无关。两组术后并发症的数量和严重程度以及LOS相当（分别为P = 0.258、P > 0.999和P = 0.467）。术后一年EA组死亡率降低（9.1%对30.9%，风险比 = 0.32，95% CI = 从0.11至到0.90，P = 0.031）。未发生与EA相关的不良事件。EA患者肠道功能恢复更早。
接受EA的患者术后疼痛控制更好，所需全身性阿片类药物更少。术后并发症和LOS无差异，尽管接受EA的患者一年生存率显著提高。肝手术中应用EA有效且安全。
