Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantation
Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantation
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DOI：
10.1002/lt.23691
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发表时间：
2013-09-01
影响因子：
4.6
通讯作者：
Kim, Tae Seok
中科院分区：
文献类型：
--
作者：
Lee, Sang Hyun;Gwak, Mi Sook;Kim, Tae Seok
随着活体肝移植的使用增加，活体肝移植的术后镇痛和护理已成为临床医生特别关注的问题。已知局部麻醉镇痛可提供有效的疼痛控制。在这项前瞻性随机研究中，我们比较了局部麻醉镇痛（PainBuster）与阿片类镇痛[鞘内吗啡（ITM）与静脉（IV）芬太尼]在肝脏供体中的术后镇痛效果。将40名成年供体随机分配到2组中的1组：ITM/IV芬太尼组（n = 21）和PainBuster组（n = 19）。PainBuster组的供体通过放置在伤口处的多孔导管（ON-Q PainBuster）接受0.5%罗哌卡因。ITM/IV芬太尼组供体术前接受ITM硫酸盐（400 g），术后持续IV芬太尼输注。术后72小时评估静息和咳嗽时的视觉模拟评分（VAS）以及急救IV芬太尼和哌替啶消耗量。记录副作用，包括镇静、头晕、恶心、呕吐、瘙痒、呼吸抑制、伤口血清肿或血肿以及首次排气时间。ITM/IV芬太尼组在术后前12小时的静息VAS评分显著较低。在其他时间，两组的VAS评分相当。在PainBuster组中，与术后前24小时相比，术后24至48小时和48至72小时的急救IV芬太尼和哌替啶使用量显著减少。PainBuster组的首次排气时间显著缩短。在副作用方面没有差异。总之，在手术后的前12小时内，ITM/IV芬太尼的镇痛效果比PainBuster更令人满意，但此后两者变得相当，PainBuster组的肠道恢复时间缩短。ITM与PainBuster的同时使用可能会在未来的调查中考虑。肝移植19：1036-1045，2013。(c)2013年AASLD。
Postoperative analgesia and care for living liver donors have become particular interests for clinicians as the use of living donor liver transplantation has increased. Local anesthetic-based analgesia has been known to provide effective pain control. In this prospective, randomized study, we compared the postoperative analgesic efficacy of local anesthetic-based analgesia (PainBuster) with the efficacy of opioid-based analgesia [intrathecal morphine (ITM) with intravenous (IV) fentanyl] in liver donors. Forty adult donors were randomly allocated to 1 of 2 groups: an ITM/IV fentanyl group (n = 21) and a PainBuster group (n = 19). Donors in the PainBuster group received 0.5% ropivacaine via a multi-orifice catheter (ON-Q PainBuster) placed at the wound. Donors in the ITM/IV fentanyl group received ITM sulfate (400 g) preoperatively and a continuous IV fentanyl infusion postoperatively. A visual analogue scale (VAS) at rest and with coughing and rescue IV fentanyl and meperidine consumption were assessed for 72 hours after the operation. Side effects, including sedation, dizziness, nausea, vomiting, pruritus, respiratory depression, wound seroma or hematoma, and the first time to flatus, were recorded. The VAS score at rest during the first 12 postoperative hours was significantly lower for the ITM/IV fentanyl group. At other times, the VAS scores were comparable between the groups. In the PainBuster group, rescue IV fentanyl and meperidine use was significantly reduced 24 to 48 hours and 48 to 72 hours after surgery in comparison with the first 24 postoperative hours. The time to first flatus was significantly reduced in the PainBuster group. There were no differences in side effects. In conclusion, analgesia was more satisfactory with ITM/IV fentanyl versus PainBuster during the first 12 hours after surgery, but they became comparable thereafter, with a shortened bowel recovery time in the PainBuster group. The concurrent use of ITM with PainBuster may be considered in a future investigation. Liver Transpl 19:1036-1045, 2013. (c) 2013 AASLD.