Møiniche S, Bülow S, Hesselfeldt P, Hestbaek A, Kehlet H
Department of Anaesthesiology, Hvidovre University Hospital, Copenhagen, Denmark.
Eur J Surg. 1995 Apr;161(4):283-8.
To evaluate the combined effects of pain relief by continuous epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection.
Uncontrolled pilot investigation.
University hospital, Denmark.
17 unselected patients (median age 69 years) undergoing colonic resection.
Patients received combined epidural and general anaesthesia during operations and after operation were given continuous epidural bupivacaine 0.25%, 4 ml hour and morphine 0.2 mg hour, for 96 hours and oral paracetamol 4 g/daily. No patient had a nasogastric tube, and oral feeding with normal food and protein enriched solutions (1000 Kcal (4180 KJ/day) was instituted 24 hours postoperatively together with intensive mobilisation.
Median visual analogue pain scores were zero at rest and minimal during coughing and mobilisation, which allowed early mobilisation for up to 11 hours on the third postoperative day. Gastrointestinal function with defaecation had returned to normal in 12 patients within the first two postoperative days. Median hospital stay was five days with minimal increase in fatigue and without postoperative weight loss.
These results suggest that a combined approach of optimal pain relief with balanced analgesia, enforced early mobilisation, and oral feeding, may reduce the length of convalescence and hospital stay after colonic operations.
评估持续硬膜外镇痛、早期经口进食和强制活动相结合对结肠切除术后康复和住院时间的综合影响。
非对照试验性研究。
丹麦大学医院。
17例接受结肠切除术的未经过筛选的患者（中位年龄69岁）。
患者在手术期间接受硬膜外麻醉和全身麻醉联合麻醉，术后给予0.25%布比卡因4毫升/小时和吗啡0.2毫克/小时持续硬膜外给药，共96小时，并给予口服对乙酰氨基酚4克/天。无一例患者留置鼻胃管，术后24小时开始经口给予正常食物和富含蛋白质的溶液（1000千卡（4180千焦/天）），同时进行强化活动。
静息时视觉模拟疼痛评分中位数为零，咳嗽和活动时疼痛评分最低，这使得术后第三天患者能够早期活动长达11小时。12例患者在术后前两天内排便的胃肠功能恢复正常。中位住院时间为5天，疲劳增加最少，且无术后体重减轻。
这些结果表明，采用平衡镇痛实现最佳疼痛缓解、强制早期活动和经口进食相结合的方法，可能会缩短结肠手术后的康复时间和住院时间。
