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Comparison of postoperative analgesic effects of thoracic epidural analgesia and rectus sheath block in laparoscopic abdominal surgery: A randomized controlled noninferiority trial

医学 外科 止痛药 麻醉 腹腔镜手术 随机对照试验 腹部外科 随机化 腹直肌鞘 可视模拟标度 不利影响 患者满意度 腹腔镜检查 腹壁 内科学
作者
Yohei Owada,Yuya Murata,Yuto Hamaguchi,Kumiko Yamada,Shinichi Inomata,Koichi Ogawa,Yusuke Ohara,Yosihimasa Akashi,Tsuyoshi Enomoto,Kazushi Maruo,Makoto Tanaka,Tatsuya Oda
出处
期刊:Asian Journal of Endoscopic Surgery [Wiley]
卷期号:16 (3): 423-431 被引量:2
标识
DOI:10.1111/ases.13180
摘要

In the Enhanced Recovery After Surgery program, abdominal wall blocks are strongly recommended as postoperative multimodal analgesia for laparoscopic abdominal surgery. The purpose of this study was to compare the efficacy of single-shot rectus sheath block (RSB) with that of thoracic epidural analgesia (TEA) as a method of multimodal analgesia in patients receiving conventional laparoscopic abdominal surgery.A noninferiority comparison was performed. Patients scheduled for laparoscopic gastric or colorectal surgery were enrolled in this study. Patients were divided randomly into two groups: TEA and RSB. The primary endpoint was the numerical rating scale (NRS) score upon coughing as of 24 hours after surgery.In total, 80 patients were randomly assigned to receive TEA (n = 42) or RSB (n = 38). Three patients were excluded from the TEA group after randomization. The NRS score on coughing as of 24 hours after surgery was significantly lower in the TEA group than in the RSB group (least square mean: 3.59 vs 6.39; 95% confidence interval for the difference: 1.87 to 3.74, P < .001). The NRS scores upon coughing and at rest were significantly lower in the TEA group than in the RSB group as of 4, 24 and 48 hours after surgery. Patient satisfaction with postoperative analgesia was significantly higher in the TEA group. Postoperative adverse events were not significantly different between groups.This is the first report of comparing RSB with TEA in laparoscopic surgery. TEA may be recommended as a multimodal analgesia protocol for laparoscopic gastric and colorectal surgery.
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