Analgesic efficacy of intrathecal morphine and bupivacaine during the early postoperative period in patients who underwent robotic-assisted laparoscopic prostatectomy: a prospective randomized controlled study.
Analgesic efficacy of intrathecal morphine and bupivacaine during the early postoperative period in patients who underwent robotic-assisted laparoscopic prostatectomy: a prospective randomized controlled study.
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DOI：
10.1186/s12894-021-00798-4
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发表时间：
2021-02-26
期刊：
影响因子：
2
通讯作者：
Chae MS
中科院分区：
文献类型：
--
作者：
Shim JW;Cho YJ;Moon HW;Park J;Lee HM;Kim YS;Moon YE;Hong SH;Chae MS
本研究旨在探讨鞘内吗啡和布比卡因（ITMB）治疗机器人辅助腹腔镜前列腺切除术（RALP）成年患者术后早期疼痛的镇痛效果。前瞻性纳入50例患者，随机分为非ITMB组（n = 25）和ITMB组（n = 25）。ITMB治疗方案为吗啡0.2 mg和布比卡因7.5 mg（共1.7 mL）。所有患者均常规给予静脉自控镇痛，并根据不知道分组分配的主治医生的判断，适当地给予静脉救援阿片类药物治疗。分别于术后1、6、24 h评估累计静脉阿片类药物消耗和数值评定量表（NRS）评分，并于术后1天测量阿片类药物相关并发症。在接受和未接受ITMB治疗的患者之间，人口统计学结果具有可比性。ITMB组术中瑞芬太尼剂量低于非ITMB组。在麻醉后护理病房（PACU，即术后1小时）和病房（即术后6小时和24小时），接受ITMB的患者休息和咳嗽时的疼痛评分（即NRS）以及累计静脉阿片类药物消耗明显低于未接受ITMB的患者。ITMB与PACU术后静息时和咳嗽时（即术后1小时）NRS评分≤3分在调整累积静脉阿片类药物消耗前后显著相关。在病房（即术后6和24小时），ITMB与术后静息时和咳嗽时NRS评分≤3相关，在调整累积静脉阿片类药物用量之前，但在调整后则无关。术中或术后硬膜穿刺后头痛、呼吸抑制、恶心、呕吐、瘙痒、神经系统后遗症等并发症无显著差异。单次脊髓注射吗啡和布比卡因提供了术后早期适当的镇痛，并减少了RALP患者静脉注射阿片类药物的额外需求。试验注册：大韩民国临床研究信息服务中心；批准文号：KCT0004350，于2019年10月17日批准。https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=15637
The present study was performed to investigate the analgesic efficacy of intrathecal morphine and bupivacaine (ITMB) in terms of treating early postoperative pain in adult patients who underwent robotic-assisted laparoscopic prostatectomy (RALP). Fifty patients were prospectively enrolled and randomly classified into the non-ITMB (n = 25) and ITMB (n = 25) groups. The ITMB therapeutic regimen consisted of 0.2 mg morphine and 7.5 mg bupivacaine (total 1.7 mL). All patients were routinely administered the intravenous patient-controlled analgesia and appropriately treated with rescue intravenous (IV) opioid drugs, based on the discretion of the attending physicians who were blinded to the group assignments. Cumulative IV opioid consumption and the numeric rating scale (NRS) score were assessed at 1, 6, and 24 h postoperatively, and opioid-related complications were measured during the day after surgery. Demographic findings were comparable between patients who did and did not receive ITMB. The intraoperative dose of remifentanil was lower in the ITMB group than in the non-ITMB group. Pain scores (i.e., NRS) at rest and during coughing as well as cumulative IV opioid consumption were significantly lower in patients who received ITMB than in those who did not in the post-anesthesia care unit (PACU; i.e., at 1 h after surgery) and the ward (i.e., at 6 and 24 h after surgery). ITMB was significantly associated with postoperative NRS scores of ≤ 3 at rest and during coughing in the PACU (i.e., at 1 h after surgery) before and after adjusting for cumulative IV opioid consumption. In the ward (i.e., at 6 and 24 h after surgery), ITMB was associated with postoperative NRS scores of ≤ 3 at rest and during coughing before adjusting for cumulative IV opioid consumption but not after. No significant differences in complications were observed, such as post-dural puncture headache, respiratory depression, nausea, vomiting, pruritus, or neurologic sequelae, during or after surgery. A single spinal injection of morphine and bupivacaine provided proper early postoperative analgesia and decreased additional requirements for IV opioids in patients who underwent RALP. Trial registration: Clinical Research Information Service, Republic of Korea; approval number: KCT0004350 on October 17, 2019. https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=15637
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影响因子：
2.3
作者：
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