| Autor: |
Koning, M. V., Ruijgrok, E. J., Teunissen, A.J.W., van der Harst, E., Stolker, R. J. |
| Předmět: |
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| Zdroj: |
Nederlands Platform voor Farmaceutisch Onderzoek; 12/15/2017, p1-2, 2p |
| Abstrakt: |
Background Pain after laparoscopic surgery is intense, but relatively short-lived when compared to open surgery. Analgesia should be tailored accordingly. Post-operative pain management after laparoscopic colonic resections remains controversial. Enhanced Recovery After Surgery (ERAS) program-guidelines recommend to limit opioid use by administration of multimodal analgesics, which includes regional anesthesia techniques and Patient Controlled Intravenous Analgesia (PCIA). In this randomized controlled trial, we compared the intrathecal administration of an admixture of morphine/bupivacaine with the standard analgetic procedure within an ERAS-program. The goal of the study was to investigate whether intrathecal morphine/ bupivacaine would lead to an enhanced recovery and limited need of systemic opioids after laparoscopic colonic surgery as compared to the standard procedure. Methods A single-center, double-blinded randomized controlled trial was performed. Patients scheduled for laparoscopic segmental intestinal resections were considered. Exclusion criteria were patients in whom contra-indications were present for spinal anesthesia, conversion to open surgery and gastric and rectal surgery. A sterilised intrathecal admixture of morphine/bupivacaine was formulated and produced by the hospital pharmacy. The intervention group received a single shot intrathecal morphine/bupivacaine (12.5 mg/300 mcg), just prior to the laparoscopic surgery. The control group received a sham procedure and a bolus of piritramide (0.1 mg/kg). Both groups received standardized general anesthesia and a PCIA-pump as postoperative analgesia. A decrease in days to “fit-fordischarge" was the primary outcome parameter. Results 56 patients were enrolled. Patients in the intervention group had an earlier “fit-for-discharge" rate (median of 3 versus 4 days, P = 0.044). Furthermore, there was a significant decrease in opioid-use and lower pain scores on the first postoperative day in the intervention group. Besides a higher incidence of pruritus in the intervention group (41% versus 8%), there were no differences in adverse events, time-to-mobilisation, fluid administration or patient satisfaction. Conclusion This RCT shows that intrathecal morphine is a more effective method of postoperative analgesia in laparoscopic surgery than intravenous opioids. These results have led to the admission of the morphine/bupivacaine intrathecal product into the hospital formulary. Studies to investigate the use of intrathecal morphine/bupivacaine in other indications are currently performed. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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