Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
BMC Urol. 2021 Feb 26;21(1):30. doi: 10.1186/s12894-021-00798-4.
BACKGROUND: The present study was performed to investigate the analgesic efficacy of intrathecal morphine and bupivacaine (ITMB) in terms of treating early postoperative pain in adult patients who underwent robotic-assisted laparoscopic prostatectomy (RALP). METHODS: Fifty patients were prospectively enrolled and randomly classified into the non-ITMB (n = 25) and ITMB (n = 25) groups. The ITMB therapeutic regimen consisted of 0.2 mg morphine and 7.5 mg bupivacaine (total 1.7 mL). All patients were routinely administered the intravenous patient-controlled analgesia and appropriately treated with rescue intravenous (IV) opioid drugs, based on the discretion of the attending physicians who were blinded to the group assignments. Cumulative IV opioid consumption and the numeric rating scale (NRS) score were assessed at 1, 6, and 24 h postoperatively, and opioid-related complications were measured during the day after surgery. RESULTS: Demographic findings were comparable between patients who did and did not receive ITMB. The intraoperative dose of remifentanil was lower in the ITMB group than in the non-ITMB group. Pain scores (i.e., NRS) at rest and during coughing as well as cumulative IV opioid consumption were significantly lower in patients who received ITMB than in those who did not in the post-anesthesia care unit (PACU; i.e., at 1 h after surgery) and the ward (i.e., at 6 and 24 h after surgery). ITMB was significantly associated with postoperative NRS scores of ≤ 3 at rest and during coughing in the PACU (i.e., at 1 h after surgery) before and after adjusting for cumulative IV opioid consumption. In the ward (i.e., at 6 and 24 h after surgery), ITMB was associated with postoperative NRS scores of ≤ 3 at rest and during coughing before adjusting for cumulative IV opioid consumption but not after. No significant differences in complications were observed, such as post-dural puncture headache, respiratory depression, nausea, vomiting, pruritus, or neurologic sequelae, during or after surgery. CONCLUSION: A single spinal injection of morphine and bupivacaine provided proper early postoperative analgesia and decreased additional requirements for IV opioids in patients who underwent RALP. TRIAL REGISTRATION: Clinical Research Information Service, Republic of Korea; approval number: KCT0004350 on October 17, 2019. https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=15637.
背景：本研究旨在探讨鞘内注射吗啡和布比卡因（ITMB）治疗行机器人辅助腹腔镜前列腺切除术（RALP）的成年患者术后早期疼痛的镇痛效果。
方法：前瞻性纳入 50 例患者，并随机分为非 ITMB 组（n=25）和 ITMB 组（n=25）。ITMB 治疗方案包括 0.2mg 吗啡和 7.5mg 布比卡因（共 1.7mL）。所有患者均常规给予静脉自控镇痛，并根据主管医生的判断，酌情给予静脉（IV）阿片类药物补救治疗，而主管医生对分组情况不知情。术后 1、6 和 24 小时评估累积 IV 阿片类药物消耗和数字评分量表（NRS）评分，并在术后当天测量与阿片类药物相关的并发症。
结果：接受和不接受 ITMB 的患者的人口统计学特征无差异。ITMB 组术中瑞芬太尼剂量低于非 ITMB 组。在麻醉后恢复室（PACU；即术后 1 小时）和病房（即术后 6 和 24 小时），接受 ITMB 的患者的静息和咳嗽时疼痛评分（即 NRS）以及累积 IV 阿片类药物消耗均显著低于未接受 ITMB 的患者。在 PACU（即术后 1 小时），校正累积 IV 阿片类药物消耗后，ITMB 与术后 NRS 评分≤3 相关；在病房（即术后 6 和 24 小时），校正累积 IV 阿片类药物消耗前，ITMB 与术后 NRS 评分≤3 相关，但校正后则无相关性。术中或术后未见明显并发症，如硬膜穿刺后头痛、呼吸抑制、恶心、呕吐、瘙痒或神经后遗症。
结论：单次脊髓注射吗啡和布比卡因可为行 RALP 的患者提供适当的术后早期镇痛，并减少对 IV 阿片类药物的额外需求。
试验注册：韩国临床试验注册中心；注册号：KCT0004350，于 2019 年 10 月 17 日注册。https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=15637.
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