硬膜外镇痛在腹疝修补术中的应用：30 天结局分析。
Epidural Analgesia in Ventral Hernia Repair: An Analysis of 30-day Outcomes.
机构信息
Jones, MD, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Brovman, MD, Wagenaar, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Whang, MD, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York. Ang, MD, Department of Surgery, Brigham and Women's Hospital, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Urman, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA.
出版信息
Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):33-47.
BACKGROUND
Ventral hernia repair (VHR) is a common procedure associated with significant postoperative morbidity and prolonged hospital length of stay (LOS). The use of epidural analgesia in VHR has not been widely evaluated.
PURPOSE
To compare the outcomes of general anesthesia plus epidural analgesia (GA + EA) versus general anesthesia alone (GA) in patients undergoing ventral hernia repair.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program database was used to identify elective cases of VHR. Propensity score-matched analysis was used to compare outcomes in GA vs GA + EA groups. Cases receiving transverse abdominus plane blocks were excluded.
RESULTS
A total of 9697 VHR cases were identified, resulting in two matched cohorts of 521 cases each. LOS was significantly longer in the GA + EA group (5.58 days) vs the GA group (5.20 days, p = 0.008). No other statistically significant differences in 30-day outcomes were observed between the matched cohorts.
CONCLUSION
Epidural analgesia in VHR is associated with statistically significant, but not clinically significant increase in LOS and may not yield any additional benefit in cases of isolated, elective VHR. Epidural analgesia may not be beneficial in this surgical population. Future studies should focus on alternative modes of analgesia to optimize pain control and outcomes for this procedure.
背景
腹壁疝修补术（VHR）是一种常见的手术，术后发病率高，住院时间长。VHR 中使用硬膜外镇痛尚未得到广泛评估。
目的
比较全身麻醉加硬膜外镇痛（GA + EA）与单纯全身麻醉（GA）在接受腹壁疝修补术患者中的效果。
方法
使用美国外科医师学会国家手术质量改进计划数据库确定择期 VHR 病例。采用倾向评分匹配分析比较 GA 与 GA + EA 组的结果。排除接受腹横肌平面阻滞的病例。
结果
共确定了 9697 例 VHR 病例，产生了两个匹配队列，每个队列各有 521 例。GA + EA 组的住院时间（5.58 天）明显长于 GA 组（5.20 天，p = 0.008）。在匹配队列中，30 天的结果没有观察到其他有统计学意义的差异。
结论
VHR 中硬膜外镇痛与 LOS 的统计学显著增加相关，但无临床意义，在孤立、择期 VHR 病例中可能不会带来任何额外益处。硬膜外镇痛在这种手术人群中可能无益。未来的研究应关注替代镇痛模式，以优化该手术的疼痛控制和结果。
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