Foster-Rain Hannah, Gatt Marcel, Davies Simon, Scott Andrew, Williams Murray
Department of Anaesthesia, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
Department of Surgery, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
J Robot Surg. 2025 Jun 16;19(1):296. doi: 10.1007/s11701-025-02461-8.
Spinal anaesthesia (SA) with intrathecal diamorphine can be utilised as part of multimodal analgesia to reduce opioid use and enhance recovery in patients undergoing major abdominal operations. There is limited evidence that this also applies to patients undergoing robotic-assisted colorectal surgery (RACS). The aim of this study was to investigate perioperative opioid administration and post-operative complications in RACS patients receiving SA versus those who received conventional analgesia (CA). Data from 201 consecutive patients undergoing RACS at York and Scarborough Teaching Hospitals NHS Foundation Trust were retrospectively included. 120 patients received SA with intrathecal diamorphine, and 81 patients received CA with oral and intravenous analgesia alone. The primary outcome was intra-operative and 24 h post-operative intravenous morphine equivalent (MEQ) administration. Secondary outcomes included post-operative nausea and vomiting, ileus, anastomotic leak, urinary retention, evidence of organ dysfunction, unplanned critical care admission, length of hospital stay, and death. There was a significant difference in both intra-operative and post-operative opioid MEQ administration in the SA group when compared to the CA group, respectively median (IQR) of 0 mg (0-6 mg) vs. 10 mg (5-15 mg), p < 0.001 and 5 mg (0-14.4 mg) vs. 20 mg (4.3-31.8 mg), p < 0.001. There were no significant differences in the secondary outcomes assessed. This study suggests that SA may be an effective form of analgesia to reduce perioperative opioid administration in RACS. This did not translate into observed improvements in secondary outcomes. These observations would need to be validated in appropriately designed prospective studies.
鞘内注射二醋吗啡的脊髓麻醉（SA）可作为多模式镇痛的一部分，以减少接受大型腹部手术患者的阿片类药物使用并促进恢复。仅有有限的证据表明这也适用于接受机器人辅助结直肠手术（RACS）的患者。本研究的目的是调查接受SA的RACS患者与接受传统镇痛（CA）的患者围手术期阿片类药物的使用情况及术后并发症。回顾性纳入了约克和斯卡伯勒教学医院国民保健服务基金会信托基金连续201例接受RACS的患者的数据。120例患者接受鞘内注射二醋吗啡的SA，81例患者仅接受口服和静脉镇痛的CA。主要结局是术中及术后24小时静脉注射吗啡当量（MEQ）。次要结局包括术后恶心呕吐、肠梗阻、吻合口漏、尿潴留、器官功能障碍证据、非计划重症监护病房入院、住院时间及死亡。与CA组相比，SA组术中及术后阿片类药物MEQ使用量均有显著差异，分别为中位数（IQR）0 mg（0 - 6 mg）对10 mg（5 - 15 mg），p < 0.001以及5 mg（0 - 14.4 mg）对20 mg（4.3 - 31.8 mg），p < 0.001。所评估的次要结局无显著差异。本研究表明，SA可能是一种有效的镇痛方式，可减少RACS患者围手术期阿片类药物的使用。但这并未转化为次要结局的明显改善。这些观察结果需要在适当设计的前瞻性研究中得到验证。
