Application of multimodal analgesia regimen in postoperative pain management after laparoscopic sleeve gastrectomy

CHEN Min; DAI Hongshan; JIANG Zhiwei; LI Shupei; YAO Miaoshi; SHU Yachun

doi:10.6039/j.issn.1001-0408.2024.21.14

您当前的位置：

首页 >

文章列表页 >

Application of multimodal analgesia regimen in postoperative pain management after laparoscopic sleeve gastrectomy

更新时间：2024-11-08

- Application of multimodal analgesia regimen in postoperative pain management after laparoscopic sleeve gastrectomy
- ZHONGGUO YAOFANG Vol. 35, Issue 21, Pages: 2658-2662(2024)
- 作者机构：
  
  1.南京中医药大学附属医院/江苏省中医院药学部，南京　210029
  2.南京中医药大学附属医院/江苏省中医院普通外科，南京　210029
  3.江苏省海滨康复医院，江苏连云港　222042
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.21.14
  CLC： R619;R982
- Published：15 November 2024，
  
  Received：10 June 2024，
  
  Revised：25 September 2024，
- 稿件说明：
移动端阅览
陈敏,戴洪山,江志伟等.多模式镇痛方案在腹腔镜袖状胃切除术后疼痛管理中的应用 ^Δ[J].中国药房,2024,35(21):2658-2662.

CHEN Min,DAI Hongshan,JIANG Zhiwei,et al.Application of multimodal analgesia regimen in postoperative pain management after laparoscopic sleeve gastrectomy[J].ZHONGGUO YAOFANG,2024,35(21):2658-2662.
陈敏,戴洪山,江志伟等.多模式镇痛方案在腹腔镜袖状胃切除术后疼痛管理中的应用 ^Δ[J].中国药房,2024,35(21):2658-2662. DOI： 10.6039/j.issn.1001-0408.2024.21.14.

CHEN Min,DAI Hongshan,JIANG Zhiwei,et al.Application of multimodal analgesia regimen in postoperative pain management after laparoscopic sleeve gastrectomy[J].ZHONGGUO YAOFANG,2024,35(21):2658-2662. DOI： 10.6039/j.issn.1001-0408.2024.21.14.

摘要

目的

探讨在加速康复外科理念指导下，多模式镇痛方案应用于腹腔镜袖状胃切除术患者术后的安全性、有效性和经济性。

方法

回顾性收集本院接受腹腔镜袖状胃切除术的减重患者数据。试验组患者采用多模式镇痛方案，即手术结束前，使用0.375%罗哌卡因局部浸润手术切口；术后静脉滴注氟比洛芬酯50 mg，每日2次；静脉滴注甲泼尼龙40 mg，每日1次；口服盐酸羟考酮缓释片10 mg，每日2次。对照组患者采用常规镇痛方案，即术后静脉滴注氟比洛芬酯100 mg，每日2次，日剂量为试验组的2倍；静脉注射地塞米松5 mg，每日1次。使用倾向性评分匹配法均衡两组基线资料，进而分别比较两组术后2、12、24、36 h运动状态和静息状态的疼痛评分，以及患者术后住院时间、总住院时间、术后首次下床时间、住院期间不良反应、住院期间药物总费用和抗菌药物费用。

结果

试验组术后2、24、36 h运动疼痛评分和2、12、24 h静息疼痛评分均显著低于对照组（

＜0.05）；术后首次下床时间、总住院时间、术后住院时间较对照组均显著缩短（

＜0.05）；肩背酸胀发生率、抗菌药物费用均显著低于对照组（

＜0.05）。两组药物总不良反应发生率和住院期间药物总费用差异无统计学意义（

＞0.05）。

结论

多模式镇痛方案镇痛效果显著，安全性好，且相比常规镇痛方案更具经济优势。

Abstract

OBJECTIVE

To explore the safety， effectiveness and cost-effectiveness of a multimodal analgesic regimen in patients who underwent laparoscopic sleeve gastrectomy under the guidance of enhanced recovery after surgery principles.

METHODS

Data from weight loss patients who underwent laparoscopic sleeve gastrectomy at our hospital were retrospectively collected. The trial group patients received a multimodal analgesic regimen， which included the use of 0.375% ropivacaine for local infiltration of the surgical incision before the end of surgery； intravenous infusion of flurbiprofen axetil 50 mg twice daily； intravenous infusion of methylprednisolone 40 mg once daily and oral administration of extended-release hydrocodone hydrochloride tablets 10 mg twice daily after surgery. The control group patients received a conventional analgesic regimen， which included intravenous infusion of flurbiprofen axetil 100 mg twice daily， with a daily dose twice that of the trial group； and intravenous injection of dexamethasone 5 mg once daily. Propensity score matching was used to balance the baseline data between the two groups. Then the pain scores during movement and at rest at 2， 12， 24 and 36 hours postoperatively， as well as the length of postoperative hospital stay， total length of hospital stay， time to first ambulation after surgery， adverse reactions during hospitalization， total drug costs， and costs of antimicrobial drugs during hospitalization were compared between the two groups.

RESULTS

The trial group had significantly lower pain scores during movement at 2， 24 and 36 hours postoperatively， and at rest at 2， 12 and 24 hours postoperatively compared to the control group （

＜0.05）. The time to first ambulation after surgery， total length of hospital stay， and length of postoperative hospital stay were significantly shorter in the trial group compared to the control group （

＜0.05）. The incidence of shoulder and back soreness， and costs of antimicrobial drugs were significantly lower in the trial group compared to the control group （

＜0.05）. No statistically significant differences were observed in the total incidence of drug-related adverse reactions and total drug costs during hospitalization between the two groups （

＞0.05）.

CONCLUSIONS

The multimodal analgesic regimen provides marked pain relief， demonstrates good safety profiles， and has a more economic advantage than the conventional analgesic regimen.

关键词

多模式镇痛腹腔镜袖状胃切除术疼痛评分术后疼痛管理

Keywords

laparoscopic sleeve gastrectomypain scorepostoperative pain management

references

DAES J，MORRELL D J，HANSSEN A，et al. Paragastric autonomic neural blockade to prevent early visceral pain and associated symptoms after laparoscopic sleeve gastrectomy：a randomized clinical trial[J]. Obes Surg，2022，32（11）：3551-3560.

XIAO Y Y，ZHANG S F，REN Q S. The new orientation of postoperative analgesia：remote ischemic preconditio- ning[J]. J Pain Res，2024，17：1145-1152.

中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重与代谢外科加速康复外科原则中国专家共识：2021版[J]. 中华消化外科杂志，2021，20（8）：841-845.

Chinese Society of Diabetes and Bariatric Surgery， Chinese Research Hospital Association. Chinese expert consensus on enhanced recovery after surgery principles in bariatric and metabolic surgery：2021 edition[J]. Chin J Dig Surg，2021，20（8）：841-845.

国家卫生健康委员会医管中心加速康复外科专家委员会，浙江省医师协会临床药师专家委员会，浙江省药学会医院药学专业委员会. 中国加速康复外科围手术期非甾体抗炎药临床应用专家共识[J]. 中华普通外科杂志，2019，34（3）：283-288.

The Accelerated Rehabilitation Surgery Expert Committee of the Medical Management Center of the National Health Commission，the Clinical Pharmacist Expert Committee of Zhejiang Medical Doctors Association，the Hospital Pharmacy Professional Committee of the Zhejiang Pharmaceutical Association. Expert consensus on clinical application of non-steroidal anti-inflammatory drugs in perioperative period of enhanced recovery after surgery in China[J]. Chin J Gen Surg，2019，34（3）：283-288.

LI Y，DOU Z，YANG L Q，et al. Oxycodone versus other opioid analgesics after laparoscopic surgery：a meta-analysis[J]. Eur J Med Res，2021，26（1）：4.

LI X X，YU L，YANG J N，et al. Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy：a randomized controlled trial[J]. BMC Anesthesiol，2019，19（1）：167.

GOTTSCHALK M B，DAWES A，HURT J，et al . A prospective randomized controlled trial of methylprednisolone for postoperative pain management of surgically treated distal radius fractures[J].J Hand Surg Am，2022 ，47（9）：866-873.

LIANG S，XING M Y，JIANG S S，et al. Effect of intravenous dexamethasone on postoperative pain in patients undergoing total knee arthroplasty：a systematic review and meta-analysis[J]. Pain Physician，2022，25（2）：E169-E183.

中华医学会外科学分会甲状腺及代谢外科学组，中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南：2019版[J]. 中国实用外科杂志，2019，39（4）：301-306.

The Thyroid and Metabolic Surgery Group of Surgical Credit Association of Chinese Medical Association，Obesity and diabetes Surgeons Committee of Surgeons Branch of Chinese Medical Association.Guidelines for surgical treatment of obesity and type 2 diabetes in China：2019 edition[J]. Chin J Pract Surg，2019，39（4）：301-306.

周嘉晖，王刚，刘江，等. 加速康复外科指导下的多模式镇痛对开腹结肠癌患者术后恢复的影响[J]. 山东大学学报（医学版），2019，57（9）：38-42.

ZHOU J H，WANG G，LIU J，et al.Effects of multimodal analgesia under the guidance of enhanced recovery after open surgery on postoperative recovery of patients with colon cancer[J]. J Shandong Univ （Health Sci），2019，57（9）：38-42.

PAN X F，WANG L M，PAN A. Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol，2021，9（6）：373-392.

YONG W，WANG J J，LENG Y，et al. Role of obesity in female reproduction[J]. Int J Med Sci，2023，20（3）：366-375.

大中华减重与代谢手术数据库研究者团队. 大中华减重与代谢手术数据库2022年度报告[J]. 中国实用外科杂志，2023，43（5）：540-551.

Greater China Metabolic and Bariatric Surgery Database Investigator Team.Greater China metabolic and bariatric surgery database registry report：2022[J]. Chin J Pract Surg，2023，43（5）：540-551.

江志伟，李宁，黎介寿. 快速康复外科的概念及临床意义[J]. 中国实用外科杂志，2007，27（2）：131-133.

JIANG Z W，LI N，LI J S. Concept and clinical significance of rapid rehabilitation surgery[J]. Chin J Pract Surg，2007，27（2）：131-133.

成汇，江志伟，沈丹丽，等. 调整阴阳平衡、减少应激是加速康复外科提升患者安全的关键[J]. 中国中西医结合杂志，2022，42（6）：744-748.

CHENG H，JIANG Z W，SHEN D L，et al.The keys of enhanced recovery after surgery to improve patient’s safety are reducing stress and adjusting balance of Yin and Yang[J].Chin J Integrated Tradit Chin West Med，2022，42（6）：744-748.

MITOBE Y，ITOU T，YAMAGUCHI Y，et al. Differences in analgesia methods for open gastrointestinal surgery are not associated with initial postoperative ambulation[J]. J Clin Med Res，2023，15（5）：255-261.

AKIRE S C，BAYRAKTAR N. Outcomes of pain management among postoperative patients：a cross-sectional study[J]. J Perianesth Nurs，2024，39（2）：240-245.

沈丹丽，成汇，江志伟，等. 刍议加速康复外科中多模式镇痛药物组合的君臣佐使之道[J]. 辽宁中医杂志，2020，47（11）：64-66.

SHEN D L，CHENG H，JIANG Z W，et al. A preliminary discussion on monarch-monarch-adjuvant-guide theory of combination of multimodal analgesic drugs in enhanced recovery after surgery（ERAS）[J]. Liaoning J Tradit Chin Med，2020，47（11）：64-66.

LALEZARI S，MUSIELAK M C，BROUN L A，et al. Laparoscopic sleeve gastrectomy as a viable option for an ambulatory surgical procedure：our 52-month experience[J]. Surg Obes Relat Dis，2018，14（6）：748-750.

JONSSON A，LIN E，PATEL L，et al. Barriers to enhanced recovery after surgery after laparoscopic sleeve gastrectomy[J]. J Am Coll Surg，2018，226（4）：605-613.

杨建军，宋致成，杨董超，等. 日间腹腔镜胃袖状切除手术可行性及安全性研究[J]. 中国实用外科杂志，2020，40（4）：429-432.

YANG J J，SONG Z C，YANG D C，et al. Preliminary study about feasibility and safety of ambulatory laparoscopic sleeve gastrectomy[J]. Chin J Pract Surg，2020，40（4）：429-432.

赵健. 加速康复外科理念在腹腔镜袖状胃切除术中的应用与思考[D].合肥：安徽医科大学，2023.

ZHAO J.The application and thinking of the concept of enhanced recovery after surgery in laparoscopic sleeve gastrectomy[D].Hefei：Anhui Medical University，2023.

陈羲箐. 关于加速康复外科在腹腔镜袖状胃切除术中的应用与探讨[D]. 昆明：昆明医科大学，2022.

CHEN X Q. Application and discussion of accelerated rehabilitation surgery in laparoscopic sleeve gastrectomy[D].Kunming：Kunming Medical University，2022.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

No data

Related Author

No data

Related Institution

No data

Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰