Intravenous Patient-controlled Analgesia Versus Thoracic Epidural Analgesia After Open Liver Surgery A Prospective, Randomized, Controlled, Noninferiority Trial
Intravenous Patient-controlled Analgesia Versus Thoracic Epidural Analgesia After Open Liver Surgery A Prospective, Randomized, Controlled, Noninferiority Trial
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DOI：
10.1097/sla.0000000000003209
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发表时间：
2019-08-01
影响因子：
9
通讯作者：
Tonnessen, Tor Inge
中科院分区：
文献类型：
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作者：
Hausken, John;Fretland, Asmund Avdem;Tonnessen, Tor Inge
目的：我们进行了一项随机、对照、非劣效性试验，以研究在接受开放性肝脏手术的患者中，静脉内、多模式、患者自控镇痛（IV-PCA）是否不劣于多模式胸段硬膜外镇痛（TEA）。随着微创技术和快速通道方案的日益普及，硬膜外镇痛作为腹部手术后疼痛管理的最佳方法的地位受到质疑。surgery.Methods:在2012年2月至2016年2月期间接受开放性肝切除术的患者被随机分配接受酮咯酸/双氯芬酸（IV-PCA，n = 66）或TEA（n = 77）增强的术后恢复方案。如果IV-PCA组术后0 - 5天的平均疼痛评分（NRS）在11分制（0 - 10）中不差于TEA组的平均疼痛评分<1分，则可宣布非劣效性。结果：主要终点，IV-PCA组的平均NRS疼痛评分为1.7，TEA组为1.6，确立了非劣效性。TEA组在POD 0和1时的疼痛评分较低，但在POD 2和5时较高或相等。IVPCA组患者的术后住院时间明显缩短（74 vs 104 h，P <0.001）。总阿片类药物的消费量在第一个3天显着降低IV-PCA group.Conclusions：IV-PCA是非劣效于TEA开放性肝切除术后疼痛的患者的治疗。关键词：住院时间，开放性肝脏手术，
Objective: We conducted a randomized, controlled, noninferiority trial to investigate if intravenous, multimodal, patient-controlled analgesia (IV-PCA) could be noninferior to multimodal thoracic epidural analgesia (TEA) in patients undergoing open liver surgery.Summary Background Data: The increasing use of minimally invasive techniques and fast track protocols have questioned the position of epidural analgesia as the optimal method of pain management after abdominal surgery.Methods: Patients operated with open liver resection between February 2012 and February 2016 were randomly assigned to receive either IV-PCA enhanced with ketorolac/diclofenac (IV-PCA, n = 66) or TEA (n = 77) within an enhanced recovery after surgery protocol. Noninferiority would be declared if the mean pain score on the numeric rating scale (NRS) for postoperative days (PODs) 0 to 5 in the IV-PCAgroupwas noworse than the mean pain score in the TEA group by a margin of < 1 point on an 11-point scale (0-10).Results: The primary endpoint, mean NRS pain score was 1.7 in the IV-PCA group and 1.6 in the TEA group, establishing noninferiority. Pain scores were lower in the TEA group on PODs 0 and 1, but higher or equal on PODs 2 and 5. Postoperative hospital stay was significantly shorter for patients in the IVPCA group (74 vs 104 h, P < 0.001). The total opioid consumption during the first 3 days was significantly lower in the IV-PCA group.Conclusions: IV-PCA was noninferior to TEA for the treatment of postoperative pain in patients undergoing open liver resection. Keywords: length of hospital stay, open liver surgery,