Resident Intensive Care Unit, Rijnstate Hospital, Arnhem, The Netherlands.
Urologist, Rijnstate Hospital, Arnhem, The Netherlands.
BMC Anesthesiol. 2023 May 22;23(1):174. doi: 10.1186/s12871-023-02141-w.
Analgesia after robot assisted radical cystectomy aims to reduce postoperative pain and opioid consumption, while facilitating early mobilization and enteral nutrition and minimizing complications. Epidural analgesia is currently recommended for an open radical cystectomy, but it is unclear if intrathecal morphine is a suiting, less-invasive alternative for a robot-assisted radical cystectomy.
The analgesic method of choice changed from epidural anesthesia to intrathecal anesthesia for patients undergoing a robot-assisted radical cystectomy. This single-center retrospective study aims to investigate if there is a difference between epidural and intrathecal analgesia in postoperative pain scores, opioid consumption, length of hospital stays and postoperative complications. An Propensity Matched Analysis was added to conventional analysis to consolidate the findings.
The study population consisted of 153 patients of whom 114 received an epidural catheter with bupivacaine/sufentanil and 39 received a single shot of intrathecal bupivacaine/morphine. Mean pain scores on the first two postoperative days (POD) were slightly higher in the intrathecal analgesia group (epidural versus intrathecal analgesia, NRS POD0: 0(0-2)[0-8] versus 1(0-3)[0-5], p = 0.050; POD1: 2(1-3)[0-8] versus 3(1-4)[0-7], p = 0.058; POD2: 2(0-3)[0-8] versus 3(2-4)[0-7], p = 0.010). Total postoperative morphine consumption was similar over the first seven days: 15 mg (5-35)[0-148] in the epidural group versus 11 mg (0-35)[0-148] in the intrathecal morphine group, p = 0.167. Length of hospital stay and time until fit for discharge where slightly higher in the epidural group (respectively 7 days (5-9)[4-42] versus 6 days (5-7)[4-38], p = 0.006, and 5 days (4-8)[3-30]) versus 5 days (4-6)[3-34], p = 0.018). There was no further difference in postoperative course.
This study showed that the effects of epidural analgesia and intrathecal morphine are comparable and that intrathecal morphine may be a suiting alternative for epidural analgesia.
机器人辅助根治性膀胱切除术术后镇痛的目的是减轻术后疼痛和阿片类药物的消耗，同时促进早期活动和肠内营养，并最大限度地减少并发症。硬膜外镇痛目前被推荐用于开放性根治性膀胱切除术，但对于机器人辅助根治性膀胱切除术，鞘内吗啡是否是一种合适的、微创替代方法尚不清楚。
本单中心回顾性研究旨在探讨机器人辅助根治性膀胱切除术后硬膜外麻醉与鞘内麻醉在术后疼痛评分、阿片类药物消耗、住院时间和术后并发症方面是否存在差异。为了巩固研究结果，我们在常规分析中加入了倾向评分匹配分析。
该研究人群包括 153 例患者，其中 114 例接受布比卡因/舒芬太尼硬膜外导管，39 例接受单次鞘内布比卡因/吗啡注射。在术后前两天（POD），鞘内镇痛组的平均疼痛评分略高（硬膜外镇痛与鞘内镇痛，NRS POD0：0（0-2）[0-8]与 1（0-3）[0-5]，p=0.050；POD1：2（1-3）[0-8]与 3（1-4）[0-7]，p=0.058；POD2：2（0-3）[0-8]与 3（2-4）[0-7]，p=0.010）。术后 7 天内总吗啡消耗量相似：硬膜外组 15mg（5-35）[0-148]，鞘内吗啡组 11mg（0-35）[0-148]，p=0.167。硬膜外组的住院时间和适合出院的时间略长（分别为 7 天（5-9）[4-42]与 6 天（5-7）[4-38]，p=0.006，和 5 天（4-8）[3-30]）与 5 天（4-6）[3-34]，p=0.018）。术后过程中没有进一步的差异。
本研究表明，硬膜外镇痛和鞘内吗啡的效果相当，鞘内吗啡可能是硬膜外镇痛的合适替代方法。
