Department of Anesthesiology, Peking University First Hospital, Beijing, China.
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
BMC Anesthesiol. 2021 Jun 28;21(1):179. doi: 10.1186/s12871-021-01399-2.
Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery.
One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events.
One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3-7.0) h vs. 6.5 (5.0-14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5-19.5) h vs.17 (13-23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3-6) ng/ml vs. 5 (3-10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000).
For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found.
ChiCTR1900026194 ; Date registered: Sep 26,2019.
我们的目的是评估基于多模式镇痛的加速康复方案对腹腔镜妇科手术后恢复质量的影响。
本前瞻性随机对照试验纳入了 140 名拟行腹腔镜妇科手术的女性患者。参与者被随机分为多模式镇痛组（研究组）或常规阿片类药物镇痛组（对照组）。多模式镇痛方案包括术前使用对乙酰氨基酚和加巴喷丁、术中使用氟比洛芬酯和罗哌卡因、术后使用对乙酰氨基酚和塞来昔布。两组均接受按需模式的患者自控镇痛泵，泵中含有吗啡作为解救镇痛药物。主要结局为术后第 2 天（POD）的恢复质量-40 评分。次要结局包括数字疼痛评分（NRS）、阿片类药物用量、临床恢复情况、C 反应蛋白和不良事件。
138 名患者完成了研究。两组患者在 POD 2 的整体 QoR-40 评分无显著差异，但研究组的疼痛维度评分较高（32.1±3.0 比 31.0±3.2，P=0.033）。在研究组中，PACU 的 NRS 疼痛评分、吗啡用量和解救镇痛药物的使用率较低[5.8%比 27.5%；P=0.0006]，下床活动时间[5.0（3.3-7.0）h 比 6.5（5.0-14.8）h；P=0.003]和肠道功能恢复时间[14.5（9.5-19.5）h 比 17（13-23.5）h；P=0.008]较短，POD 2 的 C 反应蛋白值较低[4（3-6）ng/ml 比 5（3-10.5）ng/ml；P=0.022]，患者满意度较高[9.8±0.5 比 8.8±1.2，P=0.000]。
对于微创腹腔镜妇科手术，基于多模式镇痛的加速康复方案可提供更好的镇痛效果、减少阿片类药物的使用、更早下床活动、更快肠道功能恢复和更高的患者满意度，而 QoR-40 评分无明显改善。
ChiCTR1900026194；注册日期：2019 年 9 月 26 日。
