腸内手術における腸機能回復のための静脈内リドカイン:ランダム化臨床試験
Hugh Paterson1,2, Thenmalar Vadiveloo3, Karen Innes4
1University of Edinburgh, Edinburgh, United Kingdom.
JAMA
|November 27, 2024
まとめ
術後の静脈注入のリドカインは,最小侵襲性大腸切除を受けた患者の72時間後の腸機能の回復を改善しませんでした. この研究では,リドカインとプラセボ群の回復結果において有意な差は認められませんでした.
科学分野:
- 結腸直腸手術
- 麻酔科
- 胃腸内科
背景:
- 腸機能の回復が遅れたことは コレクトミー後の一般的な合併症であり,患者の回復と退院に影響します.
- 最低侵襲手術は 回復の利点がありますが 手術後の骨髄は 課題です
研究 の 目的:
- 選択的微侵襲性大腸切除後の腸機能の回復を加速する手術前静脈注入リドカインの有効性を評価する.
主な方法:
- ALLEGRO試験はランダム化され,ダブルブラインド,プラセボ対照試験で,英国の27の病院で590人の患者が参加した.
- 患者は6時間または12時間連続注射として注射された2%の静脈内リドカインまたは塩溶液プラセボを受けた.
- 主要評価項目は,手術後72時間以内に腸機能が回復した患者の割合 (ダイエットに耐え,浮気/便を吐く) でした.
主要な成果:
- 合計557人の患者が最終分析に含まれていた (リドカイン群は279人,プラセボ群は278人).
- リドカイン群の57. 3%でプラセボ群の59. 0%で腸機能の回復が観察された (調整された絶対差: - 1. 9%;95%CI, - 8. 0%から4. 2%).
- 統計的に有意な差は,主要な結果または11の二次的結果のいずれかに見られませんでした.
結論:
- 術後の静脈内投与のリドカインは,選択的微侵襲性大腸切除後72時間以内に腸機能の回復に効果を示さなかった.
- 静脈内投与のリドカインは,この患者群で胃腸の回復を加速させるのに効果的ではないことを示唆している.
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