From the Department of General Surgery, Division of Surgical Oncology (Burchard, Melucci, Loria, Dave, Schoeniger, Galka, Moalem, Linehan).
University of Rochester School of Medicine and Dentistry (Lynch).
J Am Coll Surg. 2022 Sep 1;235(3):392-400. doi: 10.1097/XCS.0000000000000261. Epub 2022 May 4.
Single-shot intrathecal morphine (ITM) is an effective strategy for postoperative analgesia, but there are limited data on its safety, efficacy, and relationship with functional recovery among patients undergoing pancreaticoduodenectomy.
This was a retrospective review of patients undergoing pancreaticoduodenectomy from 2014 to 2020 as identified by the institutional NSQIP Hepato-pancreato-biliary database. Patients were categorized by having received no spinal analgesia, ITM, or ITM with transversus abdominus plane block (ITM+TAP). The primary outcomes were average daily pain scores from postoperative days (POD) 0 to 3, total morphine equivalents (MEQ) consumed over POD 0 to 3, and average daily inpatient MEQ from POD 4 to discharge. Secondary outcomes included the incidence of opioid related complications, length of stay, and functional recovery.
A total of 233 patients with a median age of 67 years were included. Of these, 36.5% received no spinal analgesia, 49.3% received ITM, and 14.2% received ITM+TAP. Average pain scores in POD 0 to 3 were similar by mode of spinal analgesia (none [2.8], ITM [2.6], ITM+TAP [2.3]). Total MEQ consumed from POD 0 to 3 were lower for patients who received ITM (121 mg) and ITM+TAP (132 mg), compared with no spinal analgesia (232 mg) (p < 0.0001). Average daily MEQ consumption from POD 4 to discharge was lower for ITM (18 mg) and ITM+TAP (13.1 mg) cohorts compared with no spinal analgesia (32.9 mg) (p = 0.0016). Days to functional recovery and length of stay were significantly reduced for ITM and ITM+TAP compared with no spinal analgesia. These findings remained consistent through multivariate analysis, and there were no differences in opioid-related complications among cohorts.
ITM was associated with reduced early postoperative and total inpatient opioid utilization, days to functional recovery, and length of stay among patients undergoing pancreaticoduodenectomy. ITM is a safe and effective form of perioperative analgesia that may benefit patients undergoing pancreaticoduodenectomy.
单次鞘内注射吗啡（ITM）是术后镇痛的有效策略，但关于其在胰十二指肠切除术患者中的安全性、疗效及其与功能恢复的关系的数据有限。
这是一项对 2014 年至 2020 年通过机构 NSQIP 肝胰胆数据库确定的胰十二指肠切除术患者进行的回顾性分析。患者分为未接受脊髓镇痛、ITM 或 ITM 加腹横肌平面阻滞（ITM+TAP）。主要结局是术后第 0 至 3 天的平均每日疼痛评分、术后第 0 至 3 天的总吗啡当量（MEQ）消耗量以及术后第 4 天至出院的平均每日住院 MEQ。次要结局包括阿片类药物相关并发症的发生率、住院时间和功能恢复。
共纳入 233 例中位年龄为 67 岁的患者。其中，36.5%未接受脊髓镇痛，49.3%接受 ITM，14.2%接受 ITM+TAP。不同脊髓镇痛方式下的术后第 0 至 3 天平均疼痛评分相似（无镇痛[2.8]，ITM[2.6]，ITM+TAP[2.3]）。从术后第 0 天至 3 天，接受 ITM（121mg）和 ITM+TAP（132mg）的患者的总 MEQ 消耗量低于未接受脊髓镇痛的患者（232mg）（p<0.0001）。从术后第 4 天至出院，接受 ITM（18mg）和 ITM+TAP（13.1mg）的患者的平均每日 MEQ 消耗量低于未接受脊髓镇痛的患者（32.9mg）（p=0.0016）。与未接受脊髓镇痛的患者相比，接受 ITM 和 ITM+TAP 的患者功能恢复和住院时间明显缩短。这些发现通过多变量分析仍然一致，并且在各组之间没有发现阿片类药物相关并发症的差异。
在接受胰十二指肠切除术的患者中，ITM 与减少术后早期和总住院期间阿片类药物的使用、功能恢复的天数和住院时间有关。ITM 是一种安全有效的围手术期镇痛方法，可能使接受胰十二指肠切除术的患者受益。
