医学
布比卡因
麻醉
类阿片
吗啡
剖腹手术
病人自控镇痛
随机对照试验
养生
局部麻醉剂
外科
不利影响
模式治疗法
内科学
受体
作者
Harish M Yalmanchili,Stephanie N. Buchanan,Lowell W. Chambers,Jantzen D Thorns,Nicholas A McKenzie,Alisha Reiss,Maurice P Page,Victor V Dizon,Sheila E Brooks,Lynn Shaffer,Scott Lovald,Thomas H. Hartranft,Phillip D. Price
出处
期刊:Journal of opioid management
[Weston Medical Publishers]
日期:2019-03-01
卷期号:15 (2): 169-175
被引量:3
标识
DOI:10.5055/jom.2019.0498
摘要
Objective: Efforts to achieve balance between effective pain management and opioid-related adverse events (ORAEs) have led to multimodal analgesia regimens. This study compared opioids delivered via patient-controlled analgesia (PCA) plus liposomal bupivacaine, a long-acting local anesthetic with potential to be an effective component of such regimens, to opioids delivered through PCA alone or PCA plus subcutaneous bupivacaine infusion (ONQ), following laparotomy.Design: Prospective, randomized controlled trial.Setting: Single, tertiary-care institution.Patients: One hundred patients undergoing nonemergent laparotomy.Interventions: Patients were randomly assigned to one of three study treatments: PCA only (PCAO), PCA with ONQ, or PCA with injectable liposomal bupivacaine suspension (EXP).Main Outcome Measures: Cumulative opioid use, daily mean patient-reported pain scores, and ORAEs through 72 hours postoperatively.Results: On average, the EXP (n = 31) group exhibited less than 50 percent of the total opioid consumption of the PCAO (n = 36) group, and less than 60 percent of that for the ONQ (n = 33) group. Postoperative days 1 and 3 pain scores were significantly lower for the EXP group as compared to the ONQ and PCAO groups (p ≤ 0.005). Fewer patients in the EXP group (19.4 percent) experienced ORAEs compared to the PCAO (41.1 percent) and ONQ (45.5 percent) groups (p = 0.002).Conclusions: Laparotomy patients treated with liposomal bupivacaine as part of a multimodal regimen consumed less opioids, had lower pain scores, and had fewer ORAEs. The role of liposomal bupivacaine in the postoperative care of laparotomy patients merits further study.
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