176例漏斗胸微创修复术中采用标准化胸腔镜冷冻镇痛程序后的经验教训
Lessons Learned after 176 Patients Treated with a Standardized Procedure of Thoracoscopic Cryoanalgesia during Minimally Invasive Repair of Pectus Excavatum.
作者信息
Toselli Luzia, Gigena Cecilia, Bellia-Munzon Gaston, Sanjurjo Daniela, Vallee Maxroxia, Martinez-Ferro Marcelo
机构信息
Fundacion Hospitalaria Mother and Child Medical Center, Av. Crámer 4601. Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina.
Fundacion Hospitalaria Mother and Child Medical Center, Av. Crámer 4601. Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina.
出版信息
J Pediatr Surg. 2024 Mar;59(3):372-378. doi: 10.1016/j.jpedsurg.2023.10.047. Epub 2023 Oct 21.
BACKGROUND
Intrathoracic intercostal cryoanalgesia (Cryo) during minimally invasive repair of pectus excavatum (MIRPE) reports have been related to improved pain management, although its extent differs amongst studies. We aimed to report our experience using a standardized perioperative approach including Cryo during MIRPE, and compare our actual results with those of a previous thoracic epidural analgesia (TE) cohort. Lessons learned are summarized.
METHODS
Retrospective study including patients undergoing Cryo during MIRPE between October 2018 and May 2023. Results with a standardized perioperative approach were analyzed. We then compared our Cryo cohort with a previous cohort of 62 patients who underwent TE and MIRPE between 2013 and 2018. Continuous variables were reported as mean and standard deviation, and as median (interquartile range) for variables with non-uniform distribution.
RESULTS
We performed 176 Cryo during MIRPE (16.8 ± 4.6 years), with a mean postoperative length of stay (LOS) of 1.4 ± 0.8 days and a median total requirement of 7.5 (0.0; 15.0) oral morphine equivalents (OME) (mg). Patients with Cryo had a significantly lower mean LOS (1.4 ± 0.8 vs. 3.6 ± 1.0 days, p < 0.0001), and median total opioid requirement [7.5 (0.0; 15.0) vs. 77.4 (27.0; 115.5 OME (mg), p < 0.0001) compared to TE patients. Lessons learned included ensuring adequate contact of the cryoprobe with the target, proper exposition, and specialized multidisciplinary perioperative patient and family support, including psychology and physical therapy.
CONCLUSIONS
In this study, we reported lessons learned after performing a standardized protocol of perioperative care in patients undergoing Cryo during MIRPE. This protocol enabled the achievement of a short LOS and low postoperative opioid requirement.
TYPE OF STUDY
Retrospective comparative study.
LEVEL OF EVIDENCE
III.
背景
在微创漏斗胸修复术（MIRPE）期间进行胸内肋间冷冻镇痛（Cryo）的报道显示其有助于改善疼痛管理，尽管不同研究中的效果有所差异。我们旨在报告采用标准化围手术期方法（包括在MIRPE期间使用Cryo）的经验，并将我们的实际结果与先前接受胸段硬膜外镇痛（TE）的队列进行比较。总结经验教训。
方法
回顾性研究纳入2018年10月至2023年5月期间在MIRPE期间接受Cryo的患者。分析标准化围手术期方法的结果。然后我们将接受Cryo的队列与2013年至2018年期间接受TE和MIRPE的62例患者的先前队列进行比较。连续变量报告为均值和标准差，对于分布不均匀的变量报告为中位数（四分位间距）。
结果
我们在MIRPE期间进行了176次Cryo（年龄16.8±4.6岁），术后平均住院时间（LOS）为1.4±0.8天，口服吗啡等效物（OME）总量中位数为7.5（0.0；15.0）mg。接受Cryo的患者平均LOS显著更低（1.4±0.8天对3.6±1.0天，p<0.0001），与接受TE的患者相比，总阿片类药物需求量中位数也更低[7.5（0.0；15.0）对77.4（27.0；115.5）OME（mg），p<0.0001]。经验教训包括确保冷冻探头与目标充分接触、正确暴露以及提供专门的多学科围手术期患者及家属支持，包括心理和物理治疗。
结论
在本研究中，我们报告了在接受MIRPE期间进行Cryo的患者中实施标准化围手术期护理方案后的经验教训。该方案实现了较短的LOS和较低的术后阿片类药物需求量。
研究类型
回顾性比较研究。
证据级别
III级。
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