Tsai Hsin-I, Lu Yu-Chieh, Zheng Chih-Wen, Yu Ming-Chin, Chou An-Hsun, Lee Cheng-Han, Kou Hao-Wei, Lin Jr-Rung, Lai Yu-Hua, Chang Li-Ling, Lee Chao-Wei
Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Biomedicines. 2022 Sep 27;10(10):2411. doi: 10.3390/biomedicines10102411.
Background: Adequate pain control is of crucial importance to patient recovery and satisfaction following abdominal surgeries. The optimal analgesia regimen remains controversial in liver resections. Methods: Three groups of patients undergoing open hepatectomies were retrospectively analyzed, reviewing intravenous patient-controlled analgesia (IV-PCA) versus IV-PCA in addition to bilateral rectus sheath and subcostal transversus abdominis plane nerve blocks (IV-PCA + NBs) versus patient-controlled thoracic epidural analgesia (TEA). Patient-reported pain scores and clinical data were extracted and correlated with the method of analgesia. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove the nasogastric tube and urinary catheter, time to commence on fluid and soft diet, and length of hospital stay. Results: The TEA group required less morphine over the first three postoperative days than IV-PCA and IV-PCA + NBs groups (9.21 ± 4.91 mg, 83.53 ± 49.51 mg, and 64.17 ± 31.96 mg, respectively, p < 0.001). Even though no statistical difference was demonstrated in NRS scores on the first three postoperative days at rest and on movement, the IV-PCA group showed delayed removal of urinary catheter (removal on postoperative day 4.93 ± 5.08, 3.87 ± 1.31, and 3.70 ± 1.30, respectively) and prolonged length of hospital stay (discharged on postoperative day 12.71 ± 7.26, 11.79 ± 5.71, and 10.02 ± 4.52, respectively) as compared to IV-PCA + NBs and TEA groups. Conclusions: For postoperative pain management, it is expected that the TEA group required the least amount of opioid; however, IV-PCA + NBs and TEA demonstrated comparable postoperative outcomes, namely, the time to remove nasogastric tube/urinary catheter, to start the diet, and the length of hospital stay. IV-PCA with NBs could thus be a reliable analgesic modality for patients undergoing open liver resections.
充分的疼痛控制对于腹部手术后患者的恢复和满意度至关重要。在肝切除术中，最佳镇痛方案仍存在争议。方法：对三组接受开腹肝切除术的患者进行回顾性分析，比较静脉自控镇痛（IV-PCA）、IV-PCA联合双侧腹直肌鞘和肋下腹横肌平面神经阻滞（IV-PCA + NBs）以及患者自控胸段硬膜外镇痛（TEA）。提取患者报告的疼痛评分和临床数据，并与镇痛方法相关联。结果包括术后前三天静息和活动时的吗啡总消耗量及数字评分量表（NRS）评分、拔除鼻胃管和尿管的时间、开始进食流食和软食的时间以及住院时间。结果：TEA组术后前三天所需吗啡量少于IV-PCA组和IV-PCA + NBs组（分别为9.21±4.91mg、83.53±49.51mg和64.17±31.96mg，p<0.001）。尽管术后前三天静息和活动时的NRS评分无统计学差异，但与IV-PCA + NBs组和TEA组相比，IV-PCA组尿管拔除延迟（分别于术后4.93±5.08天、3.87±1.31天和3.70±1.30天拔除）且住院时间延长（分别于术后12.71±7.26天、11.79±5.71天和10.02±4.52天出院）。结论：对于术后疼痛管理，预计TEA组所需阿片类药物量最少；然而，IV-PCA + NBs和TEA的术后结果相当，即鼻胃管/尿管拔除时间、开始进食时间和住院时间。因此，IV-PCA联合NBs对于接受开腹肝切除术的患者可能是一种可靠的镇痛方式。
