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A multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery (the LapCoGesic study).

择期腹腔镜结直肠手术围手术期镇痛策略实践变异的多中心、前瞻性、观察性队列研究 (LapCoGesic研究)。

  • 影响因子:0.72
  • DOI:10.1308/rcsann.2019.0091
  • 作者列表:"Brown L","Gray M","Griffiths B","Jones M","Madhavan A","Naru K","Shaban F","Somnath S","Harji D","NoSTRA (Northern Surgical Trainees Reseach Association).
  • 发表时间:2020-01-01
Abstract

INTRODUCTION:Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. MATERIALS AND METHODS:A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. RESULTS:A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. DISCUSSION:Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.

摘要

简介: 加速康复计划是腹腔镜结直肠手术的重要组成部分。最佳疼痛管理是强化康复计划成功的核心,被认为是一项重要的患者报告结局指标。择期腹腔镜结直肠手术采用多种镇痛策略,从患者自控镇痛到局部麻醉伤口浸润导管。然而,很少有证据表明该队列患者的最佳镇痛策略。LapCoGesic研究旨在探讨择期腹腔镜结直肠手术患者镇痛策略的差异,并评估实践中的这种差异是否对患者报告和临床结局产生影响。 材料和方法: 对择期行腹腔镜结直肠切除术的连续患者进行了为期两个月的前瞻性、多中心、观察性队列研究。主要结局指标为术后 24 小时疼痛评分。使用SPSS版本 22 进行数据分析。 结果: 共有 103 例择期行腹腔镜结直肠手术的患者纳入研究。4 例 (3.9%) 患者使用胸段硬膜外镇痛,56 例 (54.4%) 患者使用脊髓二吗啡,77 例 (74.8%) 患者使用自控镇痛。使用胸段硬膜外和脊髓二羟吗啡与术后 1 天的疼痛评分较低相关 (P <0.05)。患者自控镇痛的使用与术后疼痛评分和疼痛严重程度显著升高相关。 讨论: 择期结直肠手术患者术后疼痛以可变方式管理,这对患者报告的疼痛评分和疼痛严重程度的结局有影响。

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影响因子:2.27
发表时间:2020-04-01
DOI:10.1213/ANE.0000000000004180
作者列表:["Anderson TA","Segaran JR","Toda C","Sabouri AS","De Jonckheere J"]

METHODS:BACKGROUND:Maintaining a balance between nociception and analgesia perioperatively reduces morbidity and improves outcomes. Current intraoperative analgesic strategies are based on subjective and nonspecific parameters. The high-frequency heart rate (HR) variability index is purported to assess the balance between nociception and analgesia in patients under general anesthesia. This prospective observational study investigated whether intraoperative changes in the high-frequency HR variability index correlate with clinically relevant nociceptive stimulation and the addition of analgesics. METHODS:Instantaneous and mean high-frequency HR variability indexes were measured continuously in 79 adult subjects undergoing general anesthesia for laparoscopic cholecystectomy. The indexes were compared just before and 2 minutes after direct laryngoscopy, orogastric tube placement, first skin incision, and abdominal insufflation and just before and 6 minutes after the administration of IV hydromorphone. RESULTS:Data from 65 subjects were included in the final analysis. The instantaneous index decreased after skin incision ([SEM], 58.7 [2.0] vs 47.5 [2.0]; P < .001) and abdominal insufflation (54.0 [2.0] vs 46.3 [2.0]; P = .002). There was no change in the instantaneous index after laryngoscopy (47.2 [2.2] vs 40.3 [2.3]; P = .026) and orogastric tube placement (49.8 [2.3] vs 45.4 [2.0]; P = .109). The instantaneous index increased after hydromorphone administration (58.2 [1.9] vs 64.8 [1.8]; P = .003). CONCLUSIONS:In adult subjects under general anesthesia for laparoscopic cholecystectomy, changes in the high-frequency HR variability index reflect alterations in the balance between nociception and analgesia. This index might be used intraoperatively to titrate analgesia for individual patients. Further testing is necessary to determine whether the intraoperative use of the index affects patient outcomes.

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影响因子:2.83
发表时间:2020-03-01
DOI:10.1007/s00520-019-04881-3
作者列表:["Loprinzi C","Le-Rademacher JG","Majithia N","McMurray RP","O'Neill CR","Bendel MA","Beutler A","Lachance DH","Cheville A","Strick DM","Black DF","Tilburt JC","Smith TJ"]

METHODS:INTRODUCTION:Chemotherapy-induced peripheral neuropathy (CIPN) is a prominent clinical problem, with limited effective therapies. Preliminary non-randomized clinical trial data support that Scrambler Therapy is helpful in this situation. METHODS:Patients were eligible if they had CIPN symptoms for at least 3 months and CIPN-related tingling or pain at least 4/10 in severity during the week prior to registration. They were randomized to receive Scrambler Therapy versus transcutaneous electrical nerve stimulation (TENS) for 2 weeks. Patient-reported outcomes (PROs) were utilized to measure efficacy and toxicity daily for 2 weeks during therapy and then weekly for 8 additional weeks. RESULTS:This study accrued 50 patients, 25 to each of the 2 study arms; 46 patients were evaluable. There were twice as many Scrambler-treated patients who had at least a 50% documented improvement during the 2 treatment weeks, from their baseline pain, tingling, and numbness scores, when compared with the TENS-treated patients (from 36 to 56% compared with 16-28% for each symptom). Global Impression of Change scores for "neuropathy symptoms," pain, and quality of life were similarly improved during the treatment weeks. Patients in the Scrambler group were more likely than those in the TENS group to recommend their treatment to other patients, during both the 2-week treatment period and the 8-week follow-up period (p < 0.0001). Minimal toxicity was observed. CONCLUSIONS:The results from this pilot trial were positive, supporting the conduct of further investigations regarding the use of Scrambler Therapy for treating CIPN.

翻译标题与摘要 下载文献
影响因子:0.72
发表时间:2020-01-01
DOI:10.1308/rcsann.2019.0091
作者列表:["Brown L","Gray M","Griffiths B","Jones M","Madhavan A","Naru K","Shaban F","Somnath S","Harji D","NoSTRA (Northern Surgical Trainees Reseach Association)."]

METHODS:INTRODUCTION:Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. MATERIALS AND METHODS:A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. RESULTS:A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. DISCUSSION:Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.

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