Mărgărit Simona, Bartoș Adrian, Laza Laura, Osoian Cristiana, Turac Robert, Bondar Oszkar, Leucuța Daniel-Corneliu, Munteanu Lidia, Vasian Horațiu Nicolae
Department of Anesthesia and Intensive Care, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
"Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania.
J Clin Med. 2023 Jul 14;12(14):4682. doi: 10.3390/jcm12144682.
This systematic review explored the efficacy of different analgesic modalities and the impact on perioperative outcome in patients undergoing pancreatoduodenectomy.
A systematic literature search was performed on PubMed, Embase, Web of Science, Scopus, and Cochrane Library Database using the PRISMA framework. The primary outcome was pain scores on postoperative day one (POD1) and postoperative day two (POD2). The secondary outcomes included length of hospital stay (LOS) and specific procedure-related complications.
Five randomized controlled trials and ten retrospective cohort studies were included in the systematic review. Studies compared epidural analgesia (EA), patient-controlled analgesia (PCA), continuous wound infiltration (CWI), continuous bilateral thoracic paravertebral infusion (CTPVI), intrathecal morphine (ITM), and sublingual sufentanil. The pain scores on POD1 ( < 0.001) and POD2 ( = 0.05) were higher in the PCA group compared with the EA group. Pain scores were comparable between EA and CWI plus PCA or CTPVI on POD1 and POD2. Pain scores were comparable between EA and ITM on POD1. The procedure-related complications and length of hospital stay were not significantly different according to the type of analgesia.
EA provided lower pain scores compared with PCA on the first postoperative day after pancreatoduodenectomy; the length of hospital stay and procedure-related complications were similar between EA and PCA. CWI and CTPVI provided similar pain relief to EA.
本系统评价探讨了不同镇痛方式在胰十二指肠切除术患者中的疗效及其对围手术期结局的影响。
使用PRISMA框架在PubMed、Embase、Web of Science、Scopus和Cochrane图书馆数据库进行系统文献检索。主要结局为术后第1天（POD1）和术后第2天（POD2）的疼痛评分。次要结局包括住院时间（LOS）和特定的手术相关并发症。
该系统评价纳入了5项随机对照试验和10项回顾性队列研究。研究比较了硬膜外镇痛（EA）、患者自控镇痛（PCA）、持续伤口浸润（CWI）、持续双侧胸椎旁输注（CTPVI）、鞘内注射吗啡（ITM）和舌下含服舒芬太尼。与EA组相比，PCA组在POD1（<0.001）和POD2（=0.05）时的疼痛评分更高。在POD1和POD2时，EA与CWI加PCA或CTPVI之间的疼痛评分相当。在POD1时，EA与ITM之间的疼痛评分相当。根据镇痛类型，手术相关并发症和住院时间无显著差异。
胰十二指肠切除术后第一天，与PCA相比，EA的疼痛评分更低；EA和PCA的住院时间和手术相关并发症相似。CWI和CTPVI与EA提供的疼痛缓解效果相似。
