上部胃肠道手术的术后止痛:一个回顾性队列分析
Katrina P Pirie1,2, Andy Wang3,4,5,6, Joanna Yu6
1Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia. katrina.pirie@monash.edu.
Perioperative medicine (London, England)
|July 18, 2023
概括
胸腔外周止痛疗法在上部胃肠道手术中提供了优越的疼痛控制,与内吗啡和非神经动脉方法相比. 然而,胸外外麻醉有更高的低血压和技术失败率.
科学领域:
- 麻醉学 麻醉学
- 手术疼痛管理手术疼痛管理
- 胃肠道手术 胃肠道手术
背景情况:
- 胸腔外周止痛是一种常见的疼痛管理技术,用于上部胃肠道手术.
- 内吗啡提供了一个替代的阿片类药物节约止痛药选择,特别是在腹腔镜手术中.
研究的目的:
- 为了比较胸部外围止痛,内腔吗啡和上部胃肠道手术的非神经轴止痛的疗效和安全性.
- 为了评估手术后的吗啡消耗和疼痛控制在不同的止痛技术.
主要方法:
- 从2015年11月到2020年10月的电子病历的回顾性分析.
- 包括接受开放式,腹腔镜或转换上部胃肠道手术的患者.
- 贝叶斯混合效应建模分析术后吗啡消耗和疼痛评分.
主要成果:
- 胸部外围止痛疗法显示出优异的疼痛控制和减少了吗啡的使用,而非脑内吗啡和非神经轴止痛疗法相比.
- 内吗啡在疼痛控制和减少吗啡消耗方面优于非神经动脉止痛药.
- 胸部外周止痛与术后低血压 (60%) 和技术失败 (32%) 的更高率有关.
结论:
- 胸腔外围止痛药在上部胃肠道手术后的疼痛管理方面比内吗啡和非神经轴止痛药更有效.
- 在疼痛控制方面,胸腔外围止痛和内吗啡的益处在术后的第二天之后没有持续.
- 限制包括回顾性设计,异质的外科手术程序,以及因指示而导致的潜在混.
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