努斯手术后采用肋间神经冷冻消融术或硬膜外镇痛进行多模式疼痛治疗:一项队列研究。

IF 1.5 3区 医学 Q2 PEDIATRICS
European Journal of Pediatric Surgery Pub Date : 2024-12-01 Epub Date: 2024-01-19 DOI:10.1055/a-2249-7588
Hendrik van Braak, Sjoerd A de Beer, Justin R de Jong, Markus F Stevens, Gijsbert Musters, Sander Zwaveling, Matthijs W N Oomen, Wendeline Van der Made, Egbert Krug, L W Ernest van Heurn
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引用次数: 0

摘要

手术背景 Nuss 手术是一种微创手术,但会给患者带来疼痛。最近,肋间神经冷冻消融术作为一种止痛技术被引入。材料和方法 在这项队列研究中,我们比较了对接受努斯手术的儿童采取多模式疼痛治疗策略的效果。将肋间神经冷冻消融术联合患者自控的全身阿片类镇痛(PCA)与连续硬膜外镇痛(CEA)联合PCA的效果进行了比较。研究在 2019 年 1 月至 2022 年 7 月期间进行。主要结果为住院时间(LOS),次要结果为手术室时间、术后疼痛、阿片类药物用量和加巴喷丁用量。结果 共纳入 66 例连续患者,每组 33 例。冷冻消融组在术后第一天和第二天的数字评分量表(NRS)疼痛评分较低(p=.002,p=.001),住院时间较短(三天对六天(p=.002,p=.001))。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intercostal Nerve Cryoablation or Epidural Analgesia for Multimodal Pain Management after the Nuss Procedure: A Cohort Study.

Background:  Nuss procedure for pectus excavatum is a minimally invasive, but painful procedure. Recently, intercostal nerve cryoablation has been introduced as a pain management technique.

Materials and methods:  In this cohort study, we compared the efficacy of multimodal pain management strategies in children undergoing a Nuss procedure. The effectiveness of intercostal nerve cryoablation combined with patient-controlled systemic opioid analgesia (PCA) was compared with continuous epidural analgesia (CEA) combined with PCA. The study was conducted between January 2019 and July 2022. Primary outcome was length of stay (LOS), and secondary outcomes were operation room time, postoperative pain, opioid consumption, and gabapentin use.

Results:  Sixty-six consecutive patients were included, 33 patients in each group. The cryoablation group exhibited lower Numeric Rating Scale (NRS) pain scores on postoperative day 1 and 2 (p = 0.002, p = 0.001) and a shorter LOS (3 vs. 6 days (p < 0.001). Cryoablation resulted in less patients requiring opioids at discharge (30.3 vs. 97.0%; p < 0.001) and 1 week after surgery (6.1 vs. 45.4%; p < 0.001)). In the CEA group, gabapentin use was more prevalent (78.8 vs. 18.2%; p < 0.001) and the operation room time was shorter (119.4 vs. 135.0 minutes; p < .010). No neuropathic pain was reported.

Conclusions:  Intercostal nerve cryoablation is a superior analgesic method compared with CEA, with reduced LOS, opioid use, and NRS pain scores. The prophylactic use of gabapentin is redundant.

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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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