Department of Gastrointestinal Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK -
Department of Gastrointestinal Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Minerva Surg. 2022 Feb;77(1):57-64. doi: 10.23736/S2724-5691.21.08789-X. Epub 2021 May 28.
Intraperitoneal instillation of local anesthetic agents has been reported as an effective adjunct to pain management and early functional recovery in colorectal surgery. Laparoscopic colorectal resection (LCR) is considered as the gold standard approach to resect benign and malignant lesions of the colon and rectum due to the advantages of reduced pain score, quicker recovery, and shorter hospitalization. The objective of this study was to systematically analyze the published RCTs evaluating the effectiveness of intraperitoneal local anesthetic (IPLA) instillation versus standard analgesia in patients undergoing LCR.
Electronic databases such as Embase, Medline, PubMed, PubMed Central and the Cochrane library pertaining to the use of IPLA infiltration after LCR were systematically reviewed using the principles of meta-analysis.
Five RCTs on 292 patients undergoing LCR were either given IPLA or standard postoperative analgesia. In the random-effects model analysis using the statistical software Review Manager (Cochrane, London, UK), statistically 2-4 hours pain score (Standardized mean difference [SMD]=-1.72; 95% CI: -2.62 to -0.81; z=3.71; P=0.0002) was significantly lower in the IPLA group. The 12 hours postoperative pain score (P=0.23) was also lower in the IPLA group but failed to reach the statistical significance. Opioid analgesia requirement was lower in the IPLA group (SMD=-7.60; 95% CI: -11.21 to -3.90; z=4.12; P=0.0001) but the time to flatus, length of stay and the frequency of nausea/vomiting were statistically similar in both groups.
IPLA instillation is an effective modality to reduce the postoperative pain score and lower the opioid analgesic requirements in patients undergoing LCR without influencing the time to first flatus, length of stay, and postoperative nausea/vomiting.
局部麻醉剂腹腔内灌注已被报道为结直肠手术后疼痛管理和早期功能恢复的有效辅助手段。由于腹腔镜结直肠切除术（LCR）具有减轻疼痛评分、更快恢复和缩短住院时间的优势，被认为是切除结肠和直肠良恶性病变的金标准方法。本研究的目的是系统分析评估 LCR 术后局部麻醉剂腹腔内灌注（IPLA）与标准镇痛效果的已发表 RCT。
使用荟萃分析的原则，系统地检索了 Embase、Medline、PubMed、PubMed Central 和 Cochrane 图书馆等电子数据库中与 LCR 后 IPLA 浸润相关的研究。
5 项 RCT 纳入了 292 例行 LCR 的患者，分别给予 IPLA 或标准术后镇痛。使用统计软件 Review Manager（Cochrane，伦敦，英国）进行随机效应模型分析，在统计学上，2-4 小时疼痛评分（标准化均数差 [SMD]=-1.72；95%置信区间：-2.62 至 -0.81；z=3.71；P=0.0002）在 IPLA 组显著降低。12 小时术后疼痛评分（P=0.23）在 IPLA 组也较低，但未达到统计学意义。IPLA 组阿片类镇痛药需求较低（SMD=-7.60；95%置信区间：-11.21 至 -3.90；z=4.12；P=0.0001），但两组首次排气时间、住院时间和恶心/呕吐发生率无统计学差异。
IPLA 灌注是一种有效减少 LCR 术后疼痛评分和降低阿片类镇痛药需求的方法，而不影响首次排气时间、住院时间和术后恶心/呕吐。
