在为晚期妇科恶性瘤进行腹腔切除术的患者中定义最佳的术后止痛:一项随机对照试验
Stuart A Ostby1, Deepa Narasimhulu1, Michelle A Ochs Kinney2
1Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Gynecologic oncology
|August 8, 2024
概括
将脂质体布皮瓦卡因 (ILB) 添加到手术后增强康复 (ERAS) 途径中的内阿片类止痛药 (ITA) 并没有改善主要结果. 然而,ITA加上ILB显著减少了手术后的疼痛和阿片类药物使用,而不会增加成本.
科学领域:
- 麻醉学 麻醉学
- 术后恢复 术后恢复
- 疼痛管理 疼痛管理
背景情况:
- 手术后增强恢复 (ERAS) 途径包括多模式止痛.
- 脂质体布皮瓦卡因 (ILB) 的切口注射是某些ERAS途径的组成部分.
- 该研究调查了内阿片类止痛药 (ITA) 对现有ILB协议的附加益处.
研究的目的:
- 为了评估在ERAS途径中,在切割性脂质体布皮瓦卡因 (ILB) 添加内阿片类止痛药 (ITA) 的疗效.
- 为了确定ITA + ILB是否与单独ILB相比,改善了疼痛缓解得分 (OBAS) 的整体益处.
- 评估二次结果,包括疼痛评分,阿片类药物消费和成本.
主要方法:
- 进行了一项随机控制的非劣势性试验.
- 由于妇科恶性瘤而接受腹腔切除的患者被随机分配到单独ILB或ITA + ILB (150μg内摩).
- 主要终点是手术后24小时的OBAS;次要终点包括疼痛,阿片类药物使用和成本.
主要成果:
- 单独ILB对于主要终点 (OBAS 4vs4的中位数) 与ITA+ILB没有劣势.
- ITA + ILB组在最初24小时内显著减少了静脉输入阿片类药物使用 (26%vs71%) 和总阿片类药物需求 (中位数为7.5vs39.3毫克吗啡相当量).
- 临床相关的疼痛评分的改善有利于在术后的前16小时内ITA + ILB.
结论:
- 切口脂肪体布皮瓦卡因 (ILB) 单独是不劣于添加内阿片类止痛药 (ITA) 当通过OBAS评估时.
- 在ERAS途径中将ITA添加到ILB中,提供了成本中立的好处,包括在术后早期减少疼痛和阿片类药物消耗.
- 在ERAS协议中考虑将ITA添加到ILB中可能会优化手术后立即疼痛管理.
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