Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery
| Autor: | Erica J. Revie, O. James Garden, Stephen J. Wigmore, John A. Wilson, Dermot W. McKeown |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Male
Time Factors medicine.medical_treatment law.invention Randomized controlled trial law Prospective Studies Anesthetics Local Prospective cohort study Pain Measurement Aged 80 and over Pain Postoperative Gastroenterology analgesia Middle Aged Patient Discharge Analgesia Epidural Analgesics Opioid epidural Continuous wound infiltration Treatment Outcome Anesthesia liver resection Female Opiate wound catheter medicine.drug Adult medicine.medical_specialty Young Adult medicine Hepatectomy Humans Aged Bupivacaine Analysis of Variance Chi-Square Distribution Hepatology business.industry bupivacaine Analgesia Patient-Controlled Original Articles Length of Stay Surgery enhanced recovery Scotland business Chi-squared distribution Abdominal surgery |
| Zdroj: | HPB. 14(9):611-618 |
| ISSN: | 1365-182X |
| DOI: | 10.1111/j.1477-2574.2012.00490.x |
| Popis: | ObjectivesEpidural analgesia is recommended for the provision of analgesia following major abdominal surgery. Continuous local anaesthetic wound infiltration may be an effective alternative. A prospective randomized trial was undertaken to compare these two methods following open liver resection. The primary outcome was length of time required to fulfil criteria for discharge from hospital.MethodsPatients undergoing open liver resection were randomized to receive either epidural (EP group) or local anaesthetic wound infiltration plus patient-controlled opiate analgesia (WI group) for the first 2days postoperatively. All other care followed a standardized enhanced recovery protocol. Time to fulfil discharge criteria, pain scores, physical activity measurements and complications were recorded.ResultsBetween August 2009 and July 2010, 65 patients were randomized to EP (n= 32) or WI (n= 33). The mean time required to fulfil discharge criteria was 4.5days (range: 2.5–63.5days) in the WI group and 6.0days (range: 3.0–42.5days) in the EP group (P= 0.044). During the first 48h following surgery, pain scores were significantly lower in the EP group both at rest and on movement. Resting pain scores within both groups were rated as mild (range: 0–3). There was no significant difference between the groups in time to first mobilization or overall complication rate (48.5% in the WI group vs. 58.1% in the EP group; P= 0.443).ConclusionsLocal anaesthetic wound infiltration combined with patient-controlled opiate analgesia reduces the length of time required to fulfil criteria for discharge from hospital compared with epidural analgesia following open liver resection. Epidural analgesia provides superior analgesia, but does not confer benefits in terms of faster mobilization or recovery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text