微创食管切除术中的椎旁镇痛与硬膜外镇痛(PEPMEN):随机对照多中心试验。

IF 7.5 1区 医学 Q1 SURGERY
Minke L Feenstra, Cezanne D Kooij, Wietse J Eshuis, Eline M de Groot, Jeroen Hermanides, B Feike Kingma, Suzanne S Gisbertz, Jelle P Ruurda, Freek Daams, Marije Marsman, Oscar F C van den Bosch, Werner Ten Hoope, Lucas Goense, Misha D P Luyer, Grard A P Nieuwenhuijzen, Harm J Scholten, Marc Buise, Marc J van Det, Ewout A Kouwenhoven, Franciscus van der Meer, Geert W J Frederix, Markus W Hollmann, Edward Cheong, Mark I van Berge Henegouwen, Richard van Hillegersberg
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引用次数: 0

摘要

目的比较接受硬膜外镇痛或椎旁镇痛的微创食管切除术(MIE)患者的术后恢复质量:椎旁镇痛可能是硬膜外镇痛的一种有前途的替代方法,可避免潜在的副作用并改善术后恢复:这项随机对照优越性试验在四个荷兰中心进行,对象是计划接受经胸 MIE 和胸腔内吻合术的食管癌患者,随机分配患者接受硬膜外镇痛或椎旁镇痛。主要结果是术后第三天(POD)的恢复质量(QoR-40)。次要结果包括生活质量、术后疼痛、阿片类药物用量、肌力/血管加压药物用量、住院时间、并发症、再入院率和死亡率:从 2019 年 12 月到 2023 年 2 月,共纳入 192 名患者:94人接受硬膜外镇痛,98人接受椎旁镇痛。POD3的QoR-40评分在组间无差异(平均差异为3.7,95%CI为-2.3至9.7;P=0.268)。硬膜外麻醉患者在 POD1 和 2 的 QoR-40 评分明显更高(平均差异为 7.7,95%CI 为 2.3-13.1;P=0.018;平均差异为 7.3,95%CI 为 1.9-12.7;P=0.020),疼痛评分更低(中位数为 1 对 2;P=结论:这项随机对照试验并未证明椎旁镇痛比硬膜外镇痛在MIE术后POD3的恢复质量方面更具优势。这两种技术都很有效,可以在临床实践中使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paravertebral versus EPidural Analgesia in Minimally Invasive Esophageal ResectioN (PEPMEN): A Randomized Controlled Multicenter Trial.

Objective: To compare quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE).

Summary background data: Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery.

Methods: This randomized controlled superiority trial was conducted across four Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality.

Results: From December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference 3.7, 95%CI -2.3 to 9.7; P=0.268). Epidural patients had significant higher QoR-40 scores on POD1 and 2 (mean difference 7.7, 95%CI 2.3-13.1; P=0.018 and mean difference 7.3, 95%CI 1.9-12.7; P=0.020) and lower pain scores (median 1 versus 2; P=<0.001 and median 1 versus 2; P=0.033). More epidural patients required vasopressor medication on POD1 (38.3% versus 13.3%; P<0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 versus 4; P=<0.001). No significant differences were found in postoperative complications or hospital/Intensive Care Unit stay.

Conclusions: This randomized controlled trial did not demonstrate superiority of paravertebral over epidural analgesia regarding quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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