Department of Anesthesia, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Bangkok, Thailand.
Pain Management Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Surg Endosc. 2023 Mar;37(3):2035-2042. doi: 10.1007/s00464-022-09700-1. Epub 2022 Oct 25.
Laparoscopic liver surgery has undergone substantial advancements over the past few decades, and the key to this improvement has been an improved understanding of liver anatomy, radiologic imaging, and advancements in anesthesia and postoperative care. This study aimed to compare postoperative opioid consumption in patients receiving intrathecal morphine plus low-dose bupivacaine versus those receiving intravenous morphine.
In this randomized controlled trial, 40 patients were enrolled and randomly assigned to two groups, of which one received 0.2 mg intrathecal morphine plus 0.25% Marcaine in a total volume of 4 mL and the other received intravenous morphine intraoperatively. Pain relief and patient satisfaction were evaluated using the visual analog scale. Intraoperative blood loss was measured at the end of the surgery while morphine consumption was measured by monitoring intravenous patient-controlled morphine at 12, 24, 36, and 48 h postoperatively. Treatment efficacy and complications were documented.
Morphine consumption was significantly different in both groups at all time points, although the pain score did not show any difference. Shoulder pain, a common adverse effect of laparoscopic surgery, was significantly lower in the intrathecal group (25% vs. 75%). Blood loss and patient satisfaction were not different between the groups. However, the intrathecal group showed a significantly higher incidence of intraoperative hypotension.
Intrathecal morphine with bupivacaine can be used effectively for managing acute post-LLR pain.
TCTR20211015004.
腹腔镜肝手术在过去几十年中取得了重大进展，其关键在于对肝脏解剖、放射影像学以及麻醉和术后护理的认识不断提高。本研究旨在比较接受鞘内吗啡联合小剂量布比卡因与接受静脉吗啡的患者术后阿片类药物的消耗。
在这项随机对照试验中，纳入了 40 名患者，并随机分为两组，其中一组接受 0.2mg 鞘内吗啡加 0.25%甲哌卡因共 4ml，另一组在术中接受静脉吗啡。通过视觉模拟评分评估疼痛缓解和患者满意度。术中失血在手术结束时测量，而吗啡消耗则通过监测术后 12、24、36 和 48 小时的静脉患者自控吗啡来测量。记录治疗效果和并发症。
两组在所有时间点的吗啡消耗均有显著差异，尽管疼痛评分没有差异。腹腔镜手术常见的不良反应肩部疼痛在鞘内组明显较低（25%比 75%）。两组的失血量和患者满意度无差异。然而，鞘内组术中低血压的发生率明显较高。
鞘内吗啡联合布比卡因可有效用于管理腹腔镜肝切除术后急性疼痛。
TCTR20211015004。
