硬膜外镇痛在开腹肝切除术中的效果和结局：倾向评分匹配分析。

The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis.

机构信息

Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.

Department of Surgery, Division of Hepatobilliary Pancreatic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.

出版信息

BMC Anesthesiol. 2024 Sep 2;24(1):305. doi: 10.1186/s12871-024-02697-1.

DOI:10.1186/s12871-024-02697-1

PMID:39223470

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11367829/

Abstract

BACKGROUND

Open liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate postoperative analgesia, the potential epidural-related adverse effects should be carefully considered. This study aims to compare the efficacy and safety of continuous epidural analgesia and intravenous analgesia in open liver resection.

METHODS

A retrospective study was conducted, collecting data from patients who underwent open liver resection between 2007 and 2017. Propensity score matching was implemented to mitigate confounding variables, with patients being matched in a 1:1 ratio based on propensity scores. The primary outcome was the comparison of postoperative morphine consumption at 24, 48, and 72 hours between the two groups. Secondary outcomes included pain scores, postoperative outcomes, and epidural-related adverse effects.

RESULTS

A total of 612 patients were included, and after matching, there were 204 patients in each group. Opioid consumption at 24, 48, and 72 hours postoperatively was statistically lower in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). However, there was no significant difference in pain scores (p = 0.422). Additionally, perioperative hypotension requiring treatment, as well as nausea and vomiting, were significantly higher in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001).

CONCLUSIONS

Epidural analgesia is superior to intravenous morphine in terms of reducing postoperative opioid consumption within the initial 72 h after open liver resection. Nevertheless, perioperative hypotension, which necessitates management, should be approached with consideration and vigilance.

TRIAL REGISTRATION

The study was registered in the Clinical Trials Registry at www.

CLINICALTRIALS

gov/ , NCT number: NCT06301932.

摘要

背景

开腹肝切除术需要进行大范围的上腹部倒 L 形切口，这会导致严重的疼痛，并影响患者的康复。尽管硬膜外镇痛在提供充分的术后镇痛方面具有良好的效果，但仍需仔细考虑其潜在的硬膜外相关不良反应。本研究旨在比较连续硬膜外镇痛与静脉镇痛在开腹肝切除术中的疗效和安全性。

方法

本研究采用回顾性研究方法，收集了 2007 年至 2017 年间行开腹肝切除术患者的资料。采用倾向评分匹配法来减轻混杂因素的影响，按照倾向评分将患者以 1:1 的比例进行匹配。主要结局是比较两组患者术后 24、48 和 72 小时吗啡的消耗量。次要结局包括疼痛评分、术后结局和硬膜外相关不良反应。

结果

共纳入 612 例患者，匹配后每组各有 204 例患者。术后 24、48 和 72 小时，硬膜外镇痛组患者的阿片类药物消耗量明显低于静脉镇痛组（p<0.001）。然而，两组患者的疼痛评分差异无统计学意义（p=0.422）。此外，硬膜外镇痛组患者的围手术期低血压发生率（需要治疗的低血压）、恶心和呕吐的发生率明显高于静脉镇痛组（p<0.001）。