Tang Jefferson, Churilov Leonid, Tan Chong Oon, Hu Raymond, Pearce Brett, Cosic Luka, Christophi Christopher, Weinberg Laurence
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.
Melbourne Medical School, University of Melbourne, Heidelberg, Victoria, Australia.
BMC Anesthesiol. 2020 Aug 19;20(1):207. doi: 10.1186/s12871-020-01113-8.
Our study aimed to test the hypothesis that the addition of intrathecal morphine (ITM) results in reduced postoperative opioid use and enhanced postoperative analgesia in patients undergoing open liver resection using a standardized enhanced recovery after surgery (ERAS) protocol with multimodal analgesia.
A retrospective analysis of 216 adult patients undergoing open liver resection between June 2010 and July 2017 at a university teaching hospital was conducted. The primary outcome was the cumulative oral morphine equivalent daily dose (oMEDD) on postoperative day (POD) 1. Secondary outcomes included postoperative pain scores, opioid related complications, and length of hospital stay. We also performed a cost analysis evaluating the economic benefits of ITM.
One hundred twenty-five patients received ITM (ITM group) and 91 patients received usual care (UC group). Patient characteristics were similar between the groups. The primary outcome - cumulative oMEDD on POD1 - was significantly reduced in the ITM group. Postoperative pain scores up to 24 h post-surgery were significantly reduced in the ITM group. There was no statistically significant difference in complications or hospital stay between the two study groups. Total hospital costs were significantly higher in the ITM group.
In patients undergoing open liver resection, ITM in addition to conventional multimodal analgesic strategies reduced postoperative opioid requirements and improved analgesia for 24 h after surgery, without any statistically significant differences in opioid-related complications, and length of hospital stay. Hospital costs were significantly higher in patients receiving ITM, reflective of a longer mandatory stay in intensive care.
Registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) under ACTRN12620000001998 .
我们的研究旨在验证以下假设：对于采用标准化术后加速康复（ERAS）方案并进行多模式镇痛的肝切除术患者，鞘内注射吗啡（ITM）可减少术后阿片类药物的使用并增强术后镇痛效果。
对2010年6月至2017年7月间在一所大学教学医院接受肝切除术的216例成年患者进行回顾性分析。主要结局指标为术后第1天的口服吗啡等效每日累积剂量（oMEDD）。次要结局指标包括术后疼痛评分、阿片类药物相关并发症及住院时间。我们还进行了成本分析，以评估ITM的经济效益。
125例患者接受了ITM（ITM组），91例患者接受常规治疗（UC组）。两组患者的特征相似。主要结局指标——术后第1天的累积oMEDD——在ITM组显著降低。ITM组术后24小时内的疼痛评分显著降低。两组在并发症或住院时间方面无统计学显著差异。ITM组的总住院费用显著更高。
对于接受肝切除术的患者，在传统多模式镇痛策略基础上加用ITM可减少术后阿片类药物需求，并改善术后24小时的镇痛效果，在阿片类药物相关并发症及住院时间方面无任何统计学显著差异。接受ITM的患者住院费用显著更高，这反映了在重症监护室的强制停留时间更长。
在澳大利亚新西兰临床试验注册中心（ANZCTR）注册，注册号为ACTRN12620000001998 。
