Department of Anaesthesia and Pain, Peter MacCallum Cancer Centre, Melbourne, Australia.
Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia.
Pain Med. 2021 Feb 23;22(2):402-406. doi: 10.1093/pm/pnaa319.
Colorectal cancer surgery is commonly performed with adequate analgesia essential for patient recovery. This study assessed the effectiveness of intrathecal morphine and patient-controlled analgesia (ITM + PCA) vs patient-controlled analgesia alone (PCA) for postoperative pain management in colorectal cancer surgery.
This retrospective study extracted and analyzed data covering a 4-year period (2014-2018) from a clinical database with 24- and 48-hour postsurgery follow-up. Primary outcomes included pain scores, median opioid consumption (oral morphine equivalence dose), sedation, nausea and vomiting, and length of admission. Outcomes were analyzed for ITM + PCA vs PCA alone, overall and stratified by laparotomy or laparoscopy procedures.
In total, 283 patients were included: ITM + PCA (163) and PCA alone (120). Median opioid consumption in the first 24 hours for ITM + PCA vs PCA alone was lower for laparotomy (-32.7 mg, P<0.001) and laparoscopy (-14.3 mg, P<0.001). Median pain score (worst pain) within the first 24 hours for ITM + PCA vs PCA alone was similar for laparotomy (P>0.05) and lower for laparoscopy (-1 unit, P=0.031). Sedation occurred less frequently for ITM + PCA vs PCA at 24 hours (3.5% vs 11.4%, P=0.031), with nonsignificant reduction at 48 hours (4.8% vs 18.8%, P=0.090) for laparotomy, but with no difference for laparoscopy (P>0.05). Incidence of nausea and vomiting and length of admission were similar for ITM + PCA vs PCA alone for laparotomy or laparoscopy (P>0.05).
This retrospective study demonstrated that ITM + PCA can achieve similar analgesic effects after laparotomy and laparoscopy colorectal cancer surgery compared with PCA alone while resulting in a reduction of oral opioid consumption and lower incidence of sedation.
结直肠癌手术通常需要充分的镇痛，这对患者的恢复至关重要。本研究评估了鞘内吗啡和患者自控镇痛（ITM+PCA）与单纯患者自控镇痛（PCA）在结直肠癌手术后的镇痛效果。
这是一项回顾性研究，从一个临床数据库中提取并分析了 4 年（2014-2018 年）的数据，这些数据有 24 小时和 48 小时的术后随访。主要结局指标包括疼痛评分、阿片类药物（口服吗啡等效剂量）的中位数消耗量、镇静、恶心和呕吐以及住院时间。结果根据 ITM+PCA 与 PCA 单独治疗进行了总体分析和剖腹或腹腔镜手术分层分析。
共纳入 283 例患者：ITM+PCA（163 例）和 PCA 单独治疗（120 例）。ITM+PCA 与 PCA 单独治疗在剖腹手术中，前 24 小时内阿片类药物的中位数消耗（-32.7mg，P<0.001）和腹腔镜手术中（-14.3mg，P<0.001）均较低。前 24 小时内 ITM+PCA 与 PCA 单独治疗的疼痛评分（最痛）在剖腹手术中相似（P>0.05），而腹腔镜手术中较低（-1 分，P=0.031）。在剖腹手术中，24 小时时 ITM+PCA 比 PCA 发生镇静的频率更低（3.5% vs 11.4%，P=0.031），48 小时时的差异无统计学意义（4.8% vs 18.8%，P=0.090），而腹腔镜手术中无差异（P>0.05）。剖腹或腹腔镜手术中，ITM+PCA 与 PCA 单独治疗的恶心和呕吐发生率以及住院时间相似（P>0.05）。
本回顾性研究表明，与单纯 PCA 相比，ITM+PCA 可在剖腹和腹腔镜结直肠癌手术后获得相似的镇痛效果，同时减少口服阿片类药物的消耗和降低镇静的发生率。
