Sadik Hatem, Watson Naomi, Dilaver Nafi, Reccia Isabella, Cuell James, Pai Madhava, Sutcliffe Robert P, Baharlo Behrad
Department of Surgery and Cancer, Imperial College London, Du Cane Rd, London W12 0HS, United Kingdom.
Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, Du Cane Rd, London W12 0HS, United Kingdom.
HPB (Oxford). 2023 Jan;25(1):1-13. doi: 10.1016/j.hpb.2022.10.006. Epub 2022 Oct 17.
This study analysed whether local anaesthetic wound catheter infiltration (LA-WCI) as an adjunct to intravenous patient-controlled analgesia (IV-PCA) provides superior outcomes compared to IV-PCA alone following liver resection.
A systematic review and meta-analysis was conducted for randomised control trials (RCTs) comparing LA-WCI with IV-PCA(LA-WCI group) versus IV-PCA alone (IV-PCA group). PubMed and the Cochrane Library were searched for relevant articles.
Six RCTs with a total of 440 patients were included. Opioid use in the initial 48 h was less in the LA-WCI group [MD -21.27 mg (-39.39,-3.15), p = 0.02]. Pain scores were lower in the LA-WCI group at rest at POD0 (post-operative day 0)6-8 h (p = 0.0009), POD1AM(p = 0.01), POD1PM(p = 0.02) and POD2 (p = 0.0006), and exertion at POD0 0-2 h (p = 0.05), POD1AM(p = 0.03), POD1PM(p = 0.03), POD2 (p = 0.03) and POD3 (p = 0.01). LA-WCI group had reduced length of hospital stay [MD -1.32 days (-2.23,-0.40),p = 0.005], time to ambulation [MD -5.94 h (-8.47,-3.42),p = 0.00001] and incidence of nausea and vomiting (PONV) [OR 0.17 (0.07,0.43),p = 0.0002]. No differences were observed in length of intensive care unit (ICU) stay or incidence of surgical site infections.
LA-WCI as an adjunct to opiate IV-PCA post-hepatectomy reduces opioid use, pain scores at multiple time points at rest and exertion, length of hospital stay, time to ambulation and PONV. However, LA-WCI use does not alter length of ICU stay or incidence of wound infection.
本研究分析了局部麻醉剂伤口导管浸润（LA-WCI）作为静脉自控镇痛（IV-PCA）的辅助手段，与单纯IV-PCA相比，在肝切除术后是否能带来更好的效果。
对比较LA-WCI联合IV-PCA（LA-WCI组）与单纯IV-PCA（IV-PCA组）的随机对照试验（RCT）进行系统评价和荟萃分析。检索了PubMed和Cochrane图书馆中的相关文章。
纳入了6项RCT，共440例患者。LA-WCI组最初48小时内的阿片类药物使用量较少[MD -21.27mg（-39.39，-3.15），p = 0.02]。LA-WCI组在术后第0天（POD0）6-8小时（p = 0.0009）、POD1上午（p = 0.01）、POD1下午（p = 0.02）和POD2（p = 0.0006）休息时的疼痛评分较低，在POD0 0-2小时（p = 0.05）、POD1上午（p = 0.03）、POD1下午（p = 0.03）、POD2（p = 0.03）和POD3（p = 0.01）活动时的疼痛评分也较低。LA-WCI组的住院时间缩短[MD -1.32天（-2.23，-0.40），p = 0.005]，下床活动时间缩短[MD -5.94小时（-8.47，-3.42），p = 0.00001]，恶心呕吐（PONV）发生率降低[OR 0.17（0.07，0.43），p = 0.0002]。在重症监护病房（ICU）住院时间或手术部位感染发生率方面未观察到差异。
肝切除术后LA-WCI作为阿片类IV-PCA的辅助手段，可减少阿片类药物使用量、多个休息和活动时间点的疼痛评分、住院时间、下床活动时间和PONV。然而，使用LA-WCI不会改变ICU住院时间或伤口感染发生率。
