Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial.
Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial.
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DOI：
10.1097/aap.0000000000000703
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发表时间：
2018-03
影响因子：
5.1
通讯作者：
Stolker RJ
中科院分区：
文献类型：
--
作者：
Koning MV;Teunissen AJW;van der Harst E;Ruijgrok EJ;Stolker RJ
腹腔镜节段结肠切除术后疼痛的处理仍然存在争议。我们比较了手术后加强恢复(ERAS)计划中的两种止痛方法。这项研究的目的是调查鞘内注射布比卡因/吗啡是否会促进恢复。采用单中心、随机、双盲对照试验(NL43488.101.13)。计划行腹腔镜肠段切除术的患者被考虑在内。排除标准为有脊麻禁忌症、中转开腹手术、胃和直肠手术的患者。干预组单次鞘内注射布比卡因/吗啡(12.5 mg/300μg)，老年患者剂量不同。对照组给予假手术和吡硝胺(0.1 mg/kg)注射。两组均接受标准全麻和病人自控静脉镇痛泵作为术后镇痛。所有患者均按照ERAS方案进行治疗。主要结果是“适合出院”的天数减少了。56名患者入选。干预组患者较早出院(中位数分别为3天和4天，P=0.044)。此外，干预组在术后第一天阿片类药物的使用显著减少，疼痛评分较低。在不良事件(除了更多的瘙痒)、动员时间、液体给药或患者满意度方面没有差异。这项随机对照试验表明，鞘内注射吗啡在腹腔镜手术中是一种比ERAS方案内静脉注射阿片类药物更有效的术后镇痛方法。鞘内注射吗啡，恢复更快，疼痛更少。其他研究已经证实了这些结果，尽管关于更快恢复的数据是新的，需要在未来的试验中得到证实。这项研究在ClinicalTrials.gov上注册，编号为NCT02284282。
Management of postoperative pain after laparoscopic segmental colonic resections remains controversial. We compared 2 methods of analgesia within an Enhanced Recovery After Surgery (ERAS) program. The goal of the study was to investigate whether administration of intrathecal bupivacaine/morphine would lead to an enhanced recovery. A single-center, randomized, double-blind controlled trial was performed (NL43488.101.13). Patients scheduled for laparoscopic segmental intestinal resections were considered. Exclusion criteria were patients in whom contraindications to spinal anesthesia were present, conversion to open surgery, and gastric and rectal surgery. The intervention group received single-shot intrathecal bupivacaine/morphine (12.5 mg/300 μg), with an altered dose for older patients. The control group received a sham procedure and a bolus of piritramide (0.1 mg/kg). Both groups received standardized general anesthesia and a patient-controlled intravenous analgesia pump as postoperative analgesia. All patients were treated according to an ERAS protocol. A decrease in days to “fit for discharge” was the primary outcome. Fifty-six patients were enrolled. Intervention group patients were fit for discharge earlier (median of 3 vs 4 days, P = 0.044). Furthermore, there was a significant decrease in opioid use and lower pain scores on the first postoperative day in the intervention group. There were no differences in adverse events (except for more pruritus), time to mobilization, fluid administration, or patient satisfaction. This randomized controlled trial shows that intrathecal morphine is a more effective method of postoperative analgesia in laparoscopic surgery than intravenous opioids within an ERAS program. Recovery is faster and less painful with intrathecal morphine. Other studies have confirmed these results, although data on faster recovery are new and require confirmation in future trials. This study was registered at ClinicalTrials.gov, identifier NCT02284282.