腹壁下穿支皮瓣用于乳房重建术:术中鞘内吗啡对预后的影响

M. Aziz, K. Halenarova, E. Schröder, V. Kamps, M. Paesmans, M. Khalife, F. Urbain, M. Sosnowski
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摘要

背景:腹部下深穿支(DIEP)乳房再造术后的疼痛控制通常需要静脉麻醉镇痛和住院治疗。鞘内注射吗啡(ITM)镇痛越来越受欢迎,因为它减少了静脉注射镇痛药物的使用,并提供了相当的疼痛缓解和更小的全身副作用。问题/目的:本回顾性研究的目的是评价鞘内吗啡对腹下深穿支皮瓣乳房再造术术后发病率的影响,并与静脉麻醉镇痛进行比较。方法:269例患者在乳房切除术后立即或延迟DIEP重建,由同一位外科医生,朱尔斯博尔特研究所。采用ITM (300 μ)镇痛的患者与同一位外科医生同年采用静脉麻醉镇痛的患者以1:3的比例进行对照。评估两组患者围手术期和术后并发症的差异。结果:两组在人口学特征和发病因素方面具有可比性。除术中出血量(P = 0.0001)、输血量(P = 0.0001)和术中需水量(P = 0.0001)外,各组间术中变量差异无统计学意义。ITM组术中、术后血压均低于对照组(p < 0.05)。ITM组患者术后镇痛需求较低(P < 0.0001),呼吸并发症较少,急性呼吸衰竭较少(P = 0.003, P = 0.004)。结论:我们发现鞘内吗啡镇痛与静脉麻醉镇痛相比,出血量和给液量更少,术后疼痛控制更好,呼吸并发症更少,安全性可接受。临床意义:本研究提示鞘内使用吗啡可减少失血量和输血,更好地控制术后疼痛,减少呼吸并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Deep Inferior Epigastric Perforator Flap (D.I.E.P) for Breast Reconstruction: Impact of Intraoperative Intrathecal Morphine on Outcome
Background: Pain control after breast reconstruction with Deep Inferior Epigastric Perforator (DIEP) often requires intravenous narcotic analgesia and inpatient hospitalization. Intrathecal morphine (ITM) administration analgesia is increasing in popularity because it decreases the use of intravenous analgesic medications and offer comparable pain relief with less systemic side effects. Questions/purposes: The aim of this retrospective study was to evaluate the effect of intrathecal morphine on postoperative morbidity of breast reconstruction by Deep Inferior Epigastric Perforator flap and compare it with intravenous narcotic analgesia. Methods: 269 patients underwent immediate or delayed DIEP reconstruction after mastectomy, by the same surgeon, at Jules Bordet Institute. Patients receiving ITM analgesia (300 μ) were matched 1:3 with patients undergoing intravenous narcotic analgesia for pain control in the same years by the same surgeon. Differences in peri- and postoperative complications across the two groups were assessed. Results: The two groups were comparable in terms of demographic characteristics and factors of morbidity. Intraoperative variables were not statistically different between the groups except for intraoperative blood loss (P = 0.0001), transfusion (P = 0.0001) and Intraoperative liquid requirement (p = 0.0001). Intra and postoperative blood pressure were lower in ITM group (p < 0.05). Patients in ITM group showed lower postoperative analgesia requirement (P < 0,0001), less respiratory complications and less acute respiratory failure (P = 0,003 and P = 0,004, respectively). No statistically significant differences in the length of hospital stay (LOS) were noted Conclusion: We found that intrathecal morphine analgesia was associated with less blood loss and fluid administration, better postoperative pain control, and less respiratory complications with an acceptable security profile than intravenous narcotic analgesia. Clinical relevance: This study suggests that using intrathecal morphine may result in less blood loss and blood transfusion, better postoperative pain control, and less respiratory complications.
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