Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
BMC Surg. 2024 Oct 29;24(1):341. doi: 10.1186/s12893-024-02604-y.
Colorectal cancer (CRC) surgery in elderly patients with hypertension poses challenges due to potential complications and prolonged recovery. This study aimed to assess the impact of multimodal opioid-sparing anesthesia on intestinal function and prognosis of elderly hypertension patients undergoing CRC surgery.
A total of 80 elderly hypertension patients who underwent open surgery for CRC in the People's Hospital of Xinjiang Uygur Autonomous Region from October 2020 to October 2022 were selected and randomly divided into two group (A and B, n = 40) through the random number table method. Group A received multimodal opioid-sparing anesthesia, defined as low-dose opioid general anesthesia combined with a transversus abdominis plane block, incision infiltration with local anesthetics, and postoperative analgesia via a patient-controlled analgesia (PCA) pump, with the remifentanil dose set at one-third (± 10%) of the conventional group's dose. Group B received conventional opioid anesthesia, involving standard general anesthesia maintained with remifentanil at 0.4-0.5 µg/(kg·min), incision infiltration with local anesthetics, and postoperative PCA. Primary outcomes included mean arterial pressure (MAP) and heart rate (HR), changes in albumin, C-reactive protein (CRP) and white blood cell (WBC), indicators of intestinal function recovery (the recovery time of bowel sounds, the first exhaust time, the first defecation time and the feeding recovery time), and visual analogue scale (VAS) pain scores. Second outcomes included postoperative complications and total hospital stays.
After excluding 8 patients, 72 were included in the final analysis. Compared with patients in the B group, patients in the A group exhibited shorter recovery time of bowel sounds, first exhaust time and feeding recovery time (P < 0.05), higher levels of postoperative albumin, and lower levels of CRP and WBC (P < 0.05). Moreover, the incidence of nausea and vomiting was lower and the total hospital stays were fewer in the A group than in the B group (P < 0.05).
Multimodal opioid-sparing anesthesia contributes to rapid recovery of postoperative intestinal function and reduction of postoperative adverse reactions. Therefore, it is safe and feasible to apply multimodal opioid-sparing anesthesia to elderly hypertension patients receiving open surgery for CRC.
老年高血压患者行结直肠癌（CRC）手术存在潜在并发症和恢复时间延长等问题。本研究旨在评估多模式阿片类药物节约型麻醉对接受 CRC 手术的老年高血压患者肠道功能和预后的影响。
选取 2020 年 10 月至 2022 年 10 月在新疆维吾尔自治区人民医院接受开腹 CRC 手术的 80 例老年高血压患者，采用随机数字表法分为两组（A 组和 B 组，n=40）。A 组接受多模式阿片类药物节约型麻醉，定义为低剂量阿片类药物全身麻醉联合腹横肌平面阻滞、切口局部浸润麻醉和术后患者自控镇痛（PCA）泵镇痛，瑞芬太尼剂量设为常规组剂量的三分之一（±10%）。B 组接受常规阿片类药物麻醉，采用 0.4-0.5μg/（kg·min）的瑞芬太尼维持标准全身麻醉、切口局部浸润麻醉和术后 PCA。主要结局包括平均动脉压（MAP）和心率（HR）、白蛋白、C 反应蛋白（CRP）和白细胞（WBC）的变化、肠道功能恢复指标（肠鸣音恢复时间、首次排气时间、首次排便时间和喂养恢复时间）和视觉模拟评分（VAS）疼痛评分。次要结局包括术后并发症和总住院时间。
排除 8 例患者后，最终 72 例患者纳入分析。与 B 组相比，A 组患者肠鸣音恢复时间、首次排气时间和喂养恢复时间更短（P<0.05），术后白蛋白水平更高，CRP 和 WBC 水平更低（P<0.05）。此外，A 组恶心呕吐发生率较低，总住院时间较短（P<0.05）。
多模式阿片类药物节约型麻醉有助于促进术后肠道功能的快速恢复，减少术后不良反应。因此，对接受开腹 CRC 手术的老年高血压患者应用多模式阿片类药物节约型麻醉是安全可行的。
