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与胸段硬膜外镇痛相比,微创漏斗胸矫正术后有限冷冻消融可减少住院时间和阿片类药物消耗。

Limited cryoablation reduces hospital stay and opioid consumption compared to thoracic epidural analgesia after minimally invasive repair of pectus excavatum.

机构信息

Department of Thoracic and Cardiovascular Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.

Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Medicine (Baltimore). 2022 Aug 5;101(31):e29773. doi: 10.1097/MD.0000000000029773.

Abstract

pain following minimally invasive repair of pectus excavatum (MIRPE) is a critical concern that leads to a prolonged hospital stay and high doses of opiates administered to the patients. This study aimed to evaluate the efficacy of intraoperative cryoanalgesia (cryoablation of the intercostal nerves) during MIRPE. We retrospectively analyzed the data of 64 patients who underwent MIRPE and received cryoanalgesia or epidural analgesia between January 2019 and January 2021. The oral morphine milligram equivalent (MME) was used to calculate the dosage of opioid agents. The median age was 15 years (range, 4-33 years). The median postoperative hospital stay was 4 days (range, 2-6 days), with a median oral MME consumption of 45 mg (ranging from 0 to 1360 mg). Cryoanalgesia was performed in 38 patients, and epidural analgesia was administered to the remaining 26 patients. The cryoanalgesia group had a significantly lesser pain score, shorter postoperative hospital stay and lower oral MME consumption than the epidural analgesia group (5 vs 2; P < .001, 3 days vs 5 days; P < .001, 19 mg vs 634 mg; P < .001). Cryoanalgesia appears to reduce postoperative hospital stay and opioid consumption compared with epidural analgesia. The outcomes of this study indicate that cryoanalgesia might be a safe and effective method for pain control following MIRPE.

摘要

微创漏斗胸修复术(MIRPE)后疼痛是一个关键问题,会导致患者住院时间延长和大剂量阿片类药物的使用。本研究旨在评估术中冷冻镇痛(冷冻肋间神经)在 MIRPE 中的疗效。我们回顾性分析了 2019 年 1 月至 2021 年 1 月期间接受 MIRPE 并接受冷冻镇痛或硬膜外镇痛的 64 例患者的数据。口服吗啡毫克当量(MME)用于计算阿片类药物的剂量。中位年龄为 15 岁(范围 4-33 岁)。中位术后住院时间为 4 天(范围 2-6 天),口服 MME 中位数为 45mg(范围 0-1360mg)。38 例患者接受冷冻镇痛,其余 26 例患者接受硬膜外镇痛。与硬膜外镇痛组相比,冷冻镇痛组疼痛评分显著降低,术后住院时间和口服 MME 消耗量均明显减少(5 分比 2 分;P <.001,3 天比 5 天;P <.001,19mg 比 634mg;P <.001)。与硬膜外镇痛相比,冷冻镇痛似乎可以减少术后住院时间和阿片类药物的使用。本研究结果表明,冷冻镇痛可能是 MIRPE 后控制疼痛的一种安全有效的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8a2/9351910/cedfdc2492b7/medi-101-e29773-g001.jpg

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