Liu Xianben, Hao Wentao, Gao Kun, Xing Wenqun, Wang Zongfei, Sun Haibo, Zheng Yan
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
Ann Transl Med. 2022 Apr;10(7):393. doi: 10.21037/atm-21-4988.
Surgery is the main treatment for esophageal cancer, but postoperative incision pain seriously reduces patients' quality of life. The aim of this study was to investigate the feasibility and effectiveness of preemptive analgesia of the upper abdomen with ropivacaine in the "non-tube no fasting" fast track recovery program for esophageal carcinoma.
We retrospectively analyzed the medical records of patients who underwent minimally invasive esophagectomy (MIE) from February 2014 to August 2014. Patients in the study group underwent a conventional analgesia program together with local infiltration injection of ropivacaine in the upper abdominal incision 30 min before the operation, while patients in the control group underwent the conventional analgesia program alone. Ropivacaine was injected locally around the planned surgical incision, including intradermally, subcutaneously, in the fascial muscles, and in the parietal peritoneum layers. Li's anastomosis method was performed in the neck after MIE. No indwelling chest tube or abdominal cavity tube was placed in any patients. The use of analgesic pumps in the two groups of patients was recorded.
A total of 102 patients were enrolled in the study, with 52 patients in the study group and 50 patients in the control group. Patients in both groups completed the surgery successfully as planned, and the anesthesia methods and drugs used during the operation were the same. The surgical duration, blood loss, and the number of resected lymph nodes did not differ significantly between the two groups. Three patients in the study group and 10 patients in the control group used analgesia pumps (P=0.031). The visual analog scale (VAS) score at 30 days after surgery in the group with preemptive analgesia was significantly better than that in the control group (P=0.048).
Preemptive analgesia for the upper abdomen with ropivacaine in the "non-tube no fasting" fast track recovery program for esophageal carcinoma is feasible and worthy of promotion.
手术是食管癌的主要治疗方法，但术后切口疼痛严重降低了患者的生活质量。本研究的目的是探讨在食管癌“无管无禁食”快速康复计划中，用罗哌卡因进行上腹部超前镇痛的可行性和有效性。
我们回顾性分析了2014年2月至2014年8月接受微创食管切除术（MIE）患者的病历。研究组患者在手术前30分钟接受常规镇痛方案，并在上腹部切口局部浸润注射罗哌卡因，而对照组患者仅接受常规镇痛方案。罗哌卡因在计划手术切口周围局部注射，包括皮内、皮下、筋膜肌肉和壁腹膜层。MIE术后在颈部采用李氏吻合方法。所有患者均未留置胸管或腹腔管。记录两组患者镇痛泵的使用情况。
本研究共纳入102例患者，研究组52例，对照组50例。两组患者均按计划成功完成手术，术中麻醉方法和使用的药物相同。两组患者的手术时间、出血量和切除淋巴结数量差异无统计学意义。研究组3例患者和对照组10例患者使用了镇痛泵（P=0.031）。超前镇痛组术后30天的视觉模拟评分（VAS）明显优于对照组（P=0.048）。
在食管癌“无管无禁食”快速康复计划中，用罗哌卡因进行上腹部超前镇痛是可行的，值得推广。
