Postoperative Clinical Course and Opioid Consumption Following Repair of Congenital Diaphragmatic Hernia: Open Versus Thoracoscopic Techniques.
Postoperative Clinical Course and Opioid Consumption Following Repair of Congenital Diaphragmatic Hernia: Open Versus Thoracoscopic Techniques.
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先天性膈疝修复术后临床过程和阿片类药物消耗：开放与胸腔镜技术。
DOI：
10.1089/lap.2019.0510
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Arlyne K. Thung
中科院分区：
文献类型：
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作者：
M. J. Romnek;Karen A. Diefenbach;D. Tumin;J. Tobias;Stephanie S Kim;Arlyne K. Thung
成人胸外科手术的微创手术（MIS）方法可以改善术后过程，减少疼痛，但在新生儿中类似手术的数据有限。我们的目的是评估先天性膈疝（CDH）的新生儿和婴儿在MIS和开放式修复术后阿片类药物的消耗和疼痛管理实践。材料和方法：这是一项IRB批准的2012 - 2016年回顾性研究。人口统计数据、术中镇痛方案、术后7天阿片类药物总消耗量和辅助止痛药的使用按手术类型（开放式与MIS）进行比较。次要措施包括气管拔管时间、口服喂养时间和出院时间。结果：研究队列包括28例患者（13例女性，中位年龄5天，平均胎龄39周，体重3 kg）。8例患者行MIS。在术后前7天，MIS组的术后阿片类药物消耗中位数为0.3 mg/kg口服吗啡当量（四分位数范围[IQR] 0.2, 18.3），而开放组为32.3 mg/kg (IQR 9.9, 53.6)（中位数差异的95% CI: 8.2-42.9; P = 0.006）。术中给药阿片类药物无差异。在次要结果中，开放组的住院时间明显更长。结论：虽然有几个因素可能影响新生儿CDH的住院过程，但我们发现，与开放入路相比，MIS修复后患者的阿片类药物消费中位数差异超过100倍。该研究还指出了镇痛方案的显著差异，提示了改善术后新生儿护理的其他途径。
Introduction: Minimally invasive surgical (MIS) approaches for thoracic procedures in adults result in an improved postoperative course with less pain, but there are limited data on similar procedures in neonates. We aimed to evaluate postoperative opioid consumption and pain management practices in neonates and infants following MIS versus open repair of congenital diaphragmatic hernia (CDH). Materials and Methods: This was an IRB approved, retrospective study from 2012 to 2016. Demographic data, intraoperative analgesic regimen, total 7-day postoperative opioid consumption, and use of adjunctive pain medications were compared by surgery type (open versus MIS). Secondary measures included time to tracheal extubation, oral feeds, and discharge home. Results: The study cohort included 28 patients (13 female, median age 5 days, average gestational age 39 weeks, and weight 3 kg). MIS was performed in 8 patients. In the first 7 postoperative days, the median postoperative opioid consumption was 0.3 mg/kg of oral morphine equivalents (interquartile range [IQR] 0.2, 18.3) in the MIS group versus 32.3 mg/kg (IQR 9.9, 53.6) in the open group (95% CI of differences in medians: 8.2-42.9; P = .006). No difference was noted in intraoperative opioid administration. Among secondary outcomes, length of stay was significantly longer in the open group. Conclusions: Although several factors may impact the hospital course of neonates with CDH, we found that patients had a more than 100-fold difference in median opioid consumption following repair with MIS versus an open approach. The study also noted significant variation in analgesic regimens suggesting other avenues for improved care of postsurgical neonates.