The effect of intrathecal bupivacaine/morphine on quality of recovery in robot-assisted radical prostatectomy: a randomised controlled trial
The effect of intrathecal bupivacaine/morphine on quality of recovery in robot-assisted radical prostatectomy: a randomised controlled trial
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DOI：
10.1111/anae.14922
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发表时间：
2019-12-17
期刊：
影响因子：
10.7
通讯作者：
Stolker, R. J.
中科院分区：
文献类型：
--
作者：
Koning, M. V.;de Vlieger, R.;Stolker, R. J.
机器人辅助根治性直肠癌切除术在术后即刻引起不适。这项随机对照试验研究了除全身麻醉外，鞘内布比卡因/吗啡是否有利于术后恢复质量。155名患者被随机分配到一个干预组，接受鞘内注射12.5 mg布比卡因/300 μ g吗啡（> 75岁的患者减少20%剂量），或对照组接受皮下假注射和静脉注射0.1 mg.kg（-1）吗啡负荷剂量。两组均接受标准化全身麻醉和相同的术后镇痛方案。主要结局是术后第1天恢复质量-15（QoR-15）问卷评分下降。干预组（n = 76）在术后第1天的QoR-15降低较少;中位数（IQR [范围]）10%（1-8 [-60%至50%]）vs. 13%（5-24 [-6%至50%]），p = 0.019，并且在入院期间使用较少的吗啡; 2 mg（1-7 [0-41 mg]）vs. 15 mg（12-20 [8-61 mg]），p < 0.001。此外，他们在运动时的疼痛评分较低;数字评定量表（NRS）3（1-6 [0-9]）vs. 5（3-7 [0-9]），p = 0.001;膀胱痉挛较少（NRS 1（0-2 [0-10]）vs. 2（0-5 [0-10]），p = 0.001，镇静较少; NRS 2（0-3 [0-10]）vs. 3（2-6 [0-10]），p = 0.005。此外，干预组使用较少的补救药物。干预组瘙痒更严重; NRS 4（1-7 [0-10]）vs. 0（0-1 [0-10]），p = 0.000。我们的结论是，尽管瘙痒症的发病率略有增加，但鞘内布比卡因/吗啡的多模式疼痛管理仍然是机器人辅助根治性直肠癌切除术的可行选择。
Robot-assisted radical prostatectomy causes discomfort in the immediate postoperative period. This randomised controlled trial investigated if intrathecal bupivacaine/morphine, in addition to general anaesthesia, could be beneficial for the postoperative quality of recovery. One hundred and fifty-five patients were randomly allocated to an intervention group that received intrathecal 12.5 mg bupivacaine/300 mu g morphine (20% dose reduction in patients > 75 years) or a control group receiving a subcutaneous sham injection and an intravenous loading dose of 0.1 mg.kg(-1) morphine. Both groups received standardised general anaesthesia and the same postoperative analgesic regimen. The primary outcome was a decrease in the Quality of Recovery-15 (QoR-15) questionnaire score on postoperative day 1. The intervention group (n = 76) had less reduction in QoR-15 on postoperative day 1; median (IQR [range]) 10% (1-8 [-60% to 50%]) vs. 13% (5-24 [-6% to 50%]), p = 0.019, and used less morphine during the admission; 2 mg (1-7 [0-41 mg]) vs. 15 mg (12-20 [8-61 mg]), p < 0.001. Furthermore, they perceived lower pain scores during exertion; numeric rating scale (NRS) 3 (1-6 [0-9]) vs. 5 (3-7 [0-9]), p = 0.001; less bladder spasms (NRS 1 (0-2 [0-10]) vs. 2 (0-5 [0-10]), p = 0.001 and less sedation; NRS 2 (0-3 [0-10]) vs. 3 (2-6 [0-10]), p = 0.005. Moreover, the intervention group used less rescue medication. Pruritus was more severe in the intervention group; NRS 4 (1-7 [0-10]) vs. 0 (0-1 [0-10]), p = 0.000. We conclude that despite a modest increase in the incidence of pruritus, multimodal pain management with intrathecal bupivacaine/morphine remains a viable option for robot-assisted radical prostatectomy.