Ebara Gen, Sakuramoto Shinichi, Matsui Kazuaki, Nishibeppu Keiji, Fujita Shouhei, Fujihata Shiro, Oya Shuichiro, Lee Seigi, Miyawaki Yutaka, Sugita Hirofumi, Sato Hiroshi, Yamashita Keishi
Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan.
Surg Endosc. 2023 Nov;37(11):8245-8253. doi: 10.1007/s00464-023-10370-w. Epub 2023 Aug 31.
Laparoscopic gastrectomy is a common procedure for early gastric cancer treatment. Improving postoperative pain control enhances patient recovery after surgery. The use of multimodal analgesia can potentially enhance the analgesic effect, minimize side effects, and change the postoperative management. The purpose of this study was to evaluate and compare the efficacies of the use of patient-controlled intravenous analgesia with regular acetaminophen (PCIA + Ace) and patient-controlled thoracic epidural analgesia (PCEA) for postoperative pain control.
We retrospectively collected the data of 226 patients who underwent laparoscopic distal gastrectomy (LDG) with delta-shaped anastomosis between 2016 and 2019. After 1:1 propensity-score matching, we compared 83 patients who used PCEA alone (PCEA group) with 83 patients who used PCIA + Ace (PCIA + Ace group). Postoperative pain was assessed using a numeric rating scale (NRS) with scores ranging from 0 to 10. An NRS score ≥ 4 was considered the threshold for additional intravenous rescue medication administration.
Although NRS scores at rest were comparable between the PCEA and PCIA + Ace groups, NRS scores of patients in the PCIA + Ace group during coughing or movement were significantly better than those of patients in the PCEA group on postoperative days 2 and 3. The frequency of additional rescue analgesic use was significantly lower in the PCIA + Ace group than in the PCEA group (1.1 vs. 2.7, respectively, p < 0.001). The rate of reduction or interruption of the patient-controlled analgesic dose was higher in the PCEA group than in the PCIA + Ace group (74.6% vs. 95.1%, respectively, p = 0.0002), mainly due to hypotension occurrence in the PCEA group. Physical recovery time, postoperative complication occurrence, and liver enzyme elevation incidence were not significantly different between groups.
PCIA + Ace can be safely applied without an increase in complications or deterioration in gastrointestinal function; moreover, PCIA + Ace use may provide better pain control than PCEA use in patients following LDG.
腹腔镜胃切除术是早期胃癌治疗的常见手术。改善术后疼痛控制可促进患者术后恢复。使用多模式镇痛可能会增强镇痛效果、减少副作用并改变术后管理。本研究的目的是评估和比较患者自控静脉镇痛联合常规对乙酰氨基酚（PCIA + 对乙酰氨基酚）和患者自控胸段硬膜外镇痛（PCEA）用于术后疼痛控制的疗效。
我们回顾性收集了2016年至2019年间接受腹腔镜远端胃切除术（LDG）并采用三角吻合术的226例患者的数据。经过1:1倾向评分匹配后，我们将83例单独使用PCEA的患者（PCEA组）与83例使用PCIA + 对乙酰氨基酚的患者（PCIA + 对乙酰氨基酚组）进行了比较。使用数字评分量表（NRS）评估术后疼痛，评分范围为0至10。NRS评分≥4被视为需要额外静脉注射急救药物的阈值。
虽然PCEA组和PCIA + 对乙酰氨基酚组静息时的NRS评分相当，但在术后第2天和第3天，PCIA + 对乙酰氨基酚组患者咳嗽或活动时的NRS评分明显优于PCEA组患者。PCIA + 对乙酰氨基酚组额外使用急救镇痛药的频率明显低于PCEA组（分别为1.1和2.7，p < 0.001）。PCEA组患者自控镇痛剂量减少或中断的发生率高于PCIA + 对乙酰氨基酚组（分别为74.6%和95.1%，p = 0.0002），主要原因是PCEA组发生了低血压。两组间身体恢复时间、术后并发症发生率和肝酶升高发生率无显著差异。
PCIA + 对乙酰氨基酚可安全应用，不会增加并发症或导致胃肠功能恶化；此外，在接受LDG的患者中，使用PCIA + 对乙酰氨基酚可能比使用PCEA提供更好的疼痛控制。
