中国的机器人外科学杂志 | ISSN 2096-7721 | CN 10-1650/R

达芬奇机器人结直肠手术加速康复外科围手术期多模式止痛研究

Study on perioperative multimodal analgesia in Da Vinci robotic colorectal surgery under ERAS

作者:李玉萍,柳欣欣,刘江,江志伟,章程,邵明月,龚冠闻,王刚

Vol. 3 No. 4 Aug. 2022 DOI: 10.12180/j.issn.2096-7721.2022.04.009 发布日期:2023-10-19
关键词:多模式镇痛;纳布啡;机器人手术;结直肠手术;加速康复外科

作者简介:

在围手术期加速康复模式下应用多模式止痛方案,观察达芬奇机器人结直肠手术患者的术后镇痛及康复情况,并探讨针对内脏痛的纳布啡在术后患者加速康复中的应用价值。方法:随机选择100例择期行达芬奇机器人结直肠手术的患者,随机分为研究组(多模式镇痛组)和对照组(静脉泵镇痛组)。多模式镇痛组采用纳布啡、非甾体类镇痛药及局部麻醉浸润的联合药物镇痛方案,静脉泵镇痛组为常规静脉镇痛泵组,观察两组患者术后疼痛及康复情况。结果:和常规静脉泵镇痛组相比较,联合纳布啡的多模式镇痛组围手术期尿潴留、便秘、恶心、呕吐、眩晕、嗜睡、呼吸抑制等不良反应均较少,多模式镇痛组术后患者镇痛效果良好,下床活动、胃肠通气、进食时间更早,患者达到快速康复。结论:多模式镇痛方案有助于达芬奇机器人结直肠手术患者的围手术期快速康复,且疼痛控制良好,术后恢复较快。

To observe the postoperative analgesic and rehabilitation effect of patients underwent Da Vinci robotic colorectal surgery with perioperative multimodal analgesia under ERAS, and to explore the clinical value of nalbuphine in patients under ERAS. Methods: 100 patients underwent robotic colorectal surgery were randomly selected and divided into the study group and the control group. The study group was given multimodal analgesia combined with nalbuphine, non-steroidal analgesics and local infiltration anesthesia.The control group was given routine intravenous analgesia. The postoperative pain and recovery of the two group were observed. Results: Compared with the control group, the study group had less adverse reactions in terms of perioperative urinary retention, constipation, nausea, vomiting, dizziness, drowsiness and respiratory depression. Postoperative analgesic effect of multimodal analgesia was good, and patients in the study group achieved faster recovery with earlier off-bed time, shorter gastrointestinal ventilation and feeding time. Conclusion: Perioperative multimodal analgesia under ERAS is useful for patients underwent Da Vinci robotic colorectal surgery, which could achieve good analgesic effect and accelerate recovery after surgery.


稿件信息

收稿日期:2021-12-30 录用日期:2022-02-23

Received Date: 2021-12-30 Accepted Date: 2022-02-23

基金项目:湖北陈孝平科技发展基金(CXPJJH118000017-02-02)

Foundation Item: CHEN Xiaoping Foundation for the Development of Science and Technology of Hubei Province (CXPJJH118000017-02-02)

通讯作者:柳欣欣,Email:gorilla1999@hotmail.com

Corresponding Author: LIU Xinxin, Email: gorilla1999@hotmail.com

引用格式:李玉萍,柳欣欣,刘江,等. 达芬奇机器人结直肠手术加速康复外科围手术期多模式止痛研究[J]. 机器人外科学杂志(中英文),2022,3(4):311-318.

Citation: LI Y P, LIU X X, LIU J, et al. Study on perioperative multimodal analgesia in Da Vinci robotic colorectal surgery under ERAS[J]. Chinese Journal of Robotic Surgery, 2022, 3 (4): 311-318.


参考文献

[1] Steenhagen E. Enhanced recovery after surgery: it’s time to change practice! [J]. Nutrition in Clinical Practic,2016, 31(1): 18-29.

[2] Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme [J]. The British Journal of Surgery, 1999,86(2): 227-230.

[3] Kehlet H, Slim K. The future of fast-track surgery [J].The British Journal of Surgery, 2012, 99(8): 1025-1026.

[4] Jensen M P, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods [J].Pain, 1986, 27(1): 117-126.

[5] 刘正, 刘骞. 微创技术在结直肠肿瘤外科手术中的应用与展望[J]. 中国肿瘤临床, 2016, 43(11): 464-466.

[6] Oderda G. Challenges in the management of acute postsurgical pain [J]. Pharmacotherapy, 2012, 32(9 Suppl): 6s-11s.

[7] 江志伟, 黎介寿. 加速康复外科的现状与展望[J].浙江医学, 2016, 38(1): 9-10, 25.

[8] 董晓西, 金周晟, 夏芳芳, 等. 肋缘下腹横肌平面阻滞对胆道手术患者术后镇痛效果的影响[J]. 肝胆胰外科杂志, 2011, 23(2): 120-122.

[9] Montazeri K, Okhovat A, Honarmand A, et al. Preincisional infiltration of tonsils with dexamethasone dose not reduce posttonsillectomy vomiting and pain in children [J]. Saudi Journal of Anaesthesia, 2009, 3(2):53-56.

[10] Papagiannopoulou P, Argiriadou H, Georgiou M, et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy [J]. Surgical Endoscopy, 2003, 17(12):1961-1964.

[11] Ji R R, Kohno T, Moore K A, et al. Central sensitization and L T P : do pain and memory share similar mechanisms? [J]. Trends in Neurosciences, 2003,26(12): 696-705.

[12] Luscombe K S, Mcdonnell N J, Muchatutan A, et al. A randomised comparison of parecoxib versus placebo for pain management following minor day stay gynaecological surgery [J]. Anaesthesia and Intensive Care, 2010, 38(1): 141-148.

[13] Langford R M, Joshi G P, Gan T J, et al. Reduction in opioid-related adverse events and improvement in function with parecoxib followed by valdecoxib treatment after non-cardiac surgery: a randomized,double-blind, placebo-controlled, parallel-group trial [J].Clinical Drug Investigation, 2009, 29(9): 577-690.

[14] Gupta A, Thorn S E, Axelsson K, et al. Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy [J]. Anesthesia and Analgesia, 2002,95(2): 450-456.

[15] 陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018 版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20.

[16] Arnould J F, Pinaud M. Pharmacology of nalbuphine[J]. Annales francaises d’anesthesie et de reanimation,1992, 11(2): 221-228.

[17] Parker R K, Holtmann B, White P F. Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone [J]. Anesthesia and Analgesia, 1997,84(4): 757-763.

[18] Teter K A, Viellion G, Keating E M. Patient controlled analgesia and GI dysfunction [J]. Orthopedic Nursing,1990, 9(4): 51-56.

[19] Malinovsky J M, Lepage J Y, Karam G, et al. Nalbuphine reverses urinary effects of epidural morphine: a case report [J]. Journal of Clinical Anesthesia, 2002, 14(7):535-538.

[20] Elvir-Lazo O L, White P F. The role of multimodal analgesia in pain management after ambulatory surgery [J]. Current Opinion in Anaesthesiology, 2010, 23(6):697-703.

[21] 徐建国, 吴新民, 罗爱伦, 等. 成人术后疼痛处理专家共识[J]. 临床麻醉学杂志, 2010, 26(3): 190-196.

[22] Zsigmond E K, Winnie A P, Raza S M, et al. Nalbuphine as an analgesic component in balanced anesthesia for cardiac surgery [J]. Anesthesia and Analgesia, 1987,66(11): 1155-1164.

[23] Cohen S E, Ratner E F, Kreitzman T R, et al. Nalbuphine is better than naloxone for treatment of side effects after epidural morphine [J]. Anesthesia and Analgesia, 1992, 75(5): 747-752.

[24] Woods M P, Rayburn W F, Mcintosh D G, et al.Nalbuphine after major gynecologic surgery. Comparison of patient-controlled analgesia and intramuscular injections [J]. The Journal of Reproductive Medicine,1991, 36(9): 647-650.

[25] Mattia C, DI Bussolo E, Coluzzi F. Non-analgesic effects of opioids: the interaction of opioids with bone and joints [J]. Current Pharmaceutical Design, 2012, 18(37):6005-6009.

[26] Graham J L, Mccaughey W, Bell P F. Nalbuphine and pentazocine in an opioid-benzodiazepine sedative technique: a double-blind comparison [J]. Annals of the Royal College of Surgeons of England, 1988, 70(4):200-204.

[27] Sury M R, Cole P V. Nalbuphine combined with midazolam for outpatient sedation. An assessment of safety in volunteers [J]. Anaesthesia, 1988, 43(4): 281-284.

[28] Schultz-Machata A M, becke K, Weiss M. Nalbuphine in pediatric anesthesia [J]. Der Anaesthesist, 2014,63(2): 135-143.

[29] Bressolle F, Khier S, Rochette A, et al. Population pharmacokinetics of nalbuphine after surgery in children [J]. British Journal of Anaesthesia, 2011,106(4): 558-565.

[30] Miller R R. Evaluation of nalbuphine hydrochloride [J].American Journal of Hospital Pharmacy, 1980, 37(7):942-949.

[31] 刘韶华, 万有栋, 罗永刚, 等. 纳布啡用于ICU 患者镇痛的有效性和安全性[J]. 中华危重病急救医学,2018, 30(5): 471-476.

[32] JIANG Q, ZHANG R F, LIU T. Effect of nalbuphine on patient controlled intravenous analgesia after radical resection of colon cancer[J].Oncol Lett, 2020, 19(3):2533-2538.

[33] 江志伟, 黎介寿, 汪志明, 等. 胃癌患者应用加速康复外科治疗的安全性及有效性研究[J]. 中华外科杂志, 2007, 45(19): 1314-1317.

[34] 柳欣欣, 江志伟, 汪志明, 等. 加速康复外科在结直肠癌手术患者的应用研究[J]. 肠外与肠内营养,2007, 14(4): 205-208.

[35] LIU X X, JIANG Z W, WANG Z M, et al. Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery [J]. JPEN Journal of Parenteral and Enteral Nutrition, 2010, 34(3): 313-321.

[36] LI Y, JIANG Z W, Henrik K, et al. Is an extensive ERAS program able to bring a better outcome in contrast with standard eras program for laparoscopic colorectal cancer surgery? [J]. Annals of Surgery, 2019, 269(3): e35-e36


印象笔记
有道云笔记
微博
QQ空间
微信
二维码
意见反馈