Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study
Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study
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DOI：
10.1016/j.bja.2020.01.026
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发表时间：
2020-05-01
影响因子：
9.8
通讯作者：
Gupta, Anil
中科院分区：
文献类型：
--
作者：
Hayden, Jane M.;Oras, Jonatan;Gupta, Anil
背景：晚期卵巢癌预后较差；标准治疗是手术切除，目的是不留下残留肿瘤，然后进行辅助化疗。局部麻醉剂（LA）具有抗炎和镇痛作用。我们假设腹腔内 LA (IPLA) 将改善术后恢复、更好地缓解疼痛并更早开始化疗。 方法：这是一项前瞻性、随机、双盲、安慰剂对照试点研究，对 40 名接受开腹肿瘤细胞减灭术的女性进行了研究。患者在围手术期随机接受腹腔注射罗哌卡因（IPLA 组）或生理盐水（安慰剂组）。除研究药物外，患者接受类似治疗。术中腹腔注射罗哌卡因2 mg ml(-1)或0.9%生理盐水三次，术后经导管和镇痛泵注入腹腔72 h。记录术后疼痛、恢复时间、出院回家时间、化疗开始时间以及术后并发症。结果：未记录局麻药给药引起的并发症。各组之间的疼痛强度和救援镇痛药消耗量相似。 IPLA 组开始化疗的时间显着缩短（中位数 21 天 [四分位距 21-29] 与 29 天 [四分位距 21-40] 天；P=0.021）。其他参数包括回家准备时间、出院和发生率以及术后并发症的复杂性，两组之间相似。结论：卵巢癌细胞减灭术术后72小时内腹腔注射罗哌卡因是安全的，并且缩短了开始化疗的时间间隔。有必要进行更大规模的研究来证实这些初步发现。
Background: Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.Methods: This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml(-1) or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded.Results: No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [interquartile range 21-29] vs 29 [inter-quartile range 21-40] days; P=0.021). Other pareters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups.Conclusions: Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings.