Michael G. DeGroote School of Medicine, Hamilton, ON, Canada.
Unit of Biostatistics, St. Joseph's Healthcare, Hamilton, ON, Canada.
Minerva Anestesiol. 2021 Aug;87(8):856-863. doi: 10.23736/S0375-9393.21.15255-1. Epub 2021 Feb 17.
Intrathecal analgesia (IA) has been recommended by the enhanced recovery after surgery (ERAS) Society for laparoscopic colon resections; however, although IA is used in open liver resections, it has not been extensively studied in laparoscopic hepatobiliary surgery. This retrospective chart review was undertaken to explore postoperative pain within 48 hours among patients who underwent laparoscopic liver resections (LLR), receiving either IA with or without patient-controlled analgesia (IA±PCA) versus PCA alone.
After ethics approval, charts were reviewed for adult patients who underwent LLR between January 2016 and April 2019, and had IA±PCA or PCA alone. Patients with any contraindication to IA with morphine, obstructive sleep apnea, body mass index >40 kg/m, history of chronic pain, and/or history of drug use were excluded. Descriptive statistics used to describe postoperative pain levels at 48 hours by treatment group for each pain outcome.
Of 111 patients identified, 79 patients were finally included; 22 patients had IA±PCA and 57 patients had PCA only. There were no statistically significant differences in baseline characteristics, use of non-opioid pain control, and postoperative complications between the two groups. IA use was associated with reduced postoperative opioid consumption (measured in oral morphine equivalents) compared to PCA alone (mean difference [95% confidence interval] -45.92 [-83.10 to -8.75]; P=0.016).
IA has the potential to decrease postoperative opioid use for patients undergoing LLR, and appears to be safe and effective in the setting of LLR. These findings are consistent with the ERAS Society recommendations for laparoscopic colorectal surgery.
加速康复外科（ERAS）协会推荐椎管内镇痛（IA）用于腹腔镜结肠切除术；然而，尽管 IA 用于开腹肝切除术，但在腹腔镜肝胆手术中尚未广泛研究。本回顾性图表研究旨在探讨接受 IA 联合或不联合患者自控镇痛（IA±PCA）与单独 PCA 的腹腔镜肝切除术（LLR）患者在术后 48 小时内的术后疼痛情况。
在获得伦理批准后，对 2016 年 1 月至 2019 年 4 月期间接受 LLR 且接受 IA±PCA 或单独 PCA 的成年患者的图表进行了回顾。排除对 IA 联合吗啡、阻塞性睡眠呼吸暂停、BMI>40 kg/m、慢性疼痛史和/或药物使用史有任何禁忌的患者。使用描述性统计方法，根据治疗组描述术后 48 小时的每个疼痛结局的疼痛水平。
共确定 111 例患者，最终纳入 79 例患者；22 例患者接受 IA±PCA，57 例患者接受 PCA 单独治疗。两组在基线特征、非阿片类药物疼痛控制的使用和术后并发症方面无统计学差异。与单独 PCA 相比，IA 组术后阿片类药物消耗减少（以口服吗啡当量衡量）（平均差值[95%置信区间]-45.92[-83.10 至-8.75]；P=0.016）。
IA 有潜力减少接受 LLR 患者的术后阿片类药物使用，并且在 LLR 中似乎是安全有效的。这些发现与 ERAS 协会推荐腹腔镜结直肠手术一致。
