在门诊性直肠外科手术中实施多模式增强恢复协议:随机试验
Lucille Y Yao1, Aaron B Parrish1,2, Phillip R Fleshner1
1Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California.
Diseases of the colon and rectum
|July 17, 2024
概括
增强的恢复途径显著减少了在门诊直肠外科手术中术后阿片类药物的使用. 为减少阿片类药物消耗,建议在和手术中使用多种模式的止痛药.
科学领域:
- 麻醉学 麻醉学
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
背景情况:
- 增强恢复途径 (ERP) 在门诊直肠外科手术中没有得到充分研究.
- 在这种情况下,多模式止痛可能会减少术后阿片类药物的使用.
研究的目的:
- 为了比较手术后的阿片类药物的使用,在患者接受门诊性门外科手术与多式联络性止痛与标准护理.
- 评估增强恢复途径在减少阿片类药物消费方面的有效性.
主要方法:
- 在城市教学医院进行前性随机试验 (2018年9月 - 2022年5月).
- 包括18至70岁的成年人接受选择性囊或瘤手术.
- 干预:多模式ERP与非阿片类药物止痛药 (乙氨基, gabapentin, ketorolac);控制:标准护理.
主要成果:
- 89名患者完成了这项研究;中位数年龄38岁,女性46%.
- 在第一周的阿片类药物使用 (口服吗啡毫克相当量) 在ERP组 (8毫克) 与标准护理组 (79毫克;p = 0.002) 相比显着较低.
- 在二次结果 (疼痛,恶心,不良事件,入院) 中没有发现显著差异.
结论:
- 通过多模式止痛疗法的增强恢复途径有效地减少了在选择性囊和瘤手术中的术后阿片类药物使用.
- 这些协议应考虑在类似程序中进行常规实施.
- 这些发现是针对囊和瘤手术的具体发现,可能不适用于其他直肠手术.
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