|
|
| [PMID]: | 28746153 |
| [Au] Autor: | Aloia TA; Kim BJ; Segraves-Chun YS; Cata JP; Truty MJ; Shi Q; Holmes A; Soliz JM; Popat KU; Rahlfs TF; Lee JE; Wang XS; Morris JS; Gottumukkala VNR; Vauthey JN |
| [Ad] Endereço: | *Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX †Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX ‡Department of Surgery, Mayo Clinic, Rochester, MN §Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX ¶Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX. |
| [Ti] Título: | A Randomized Controlled Trial of Postoperative Thoracic Epidural Analgesia Versus Intravenous Patient-controlled Analgesia After Major Hepatopancreatobiliary Surgery. |
| [So] Source: | Ann Surg;266(3):545-554, 2017 09. | | [Is] ISSN: | 1528-1140 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | OBJECTIVES: The primary objective of this randomized trial was to compare thoracic epidural analgesia (TEA) to intravenous patient-controlled analgesia (IV-PCA) for pain control over the first 48 hours after hepatopancreatobiliary (HPB) surgery. Secondary endpoints were patient-reported outcomes, total narcotic utilization, and complications. BACKGROUND: Although adequate postoperative pain control is critical to patient and surgeon success, the optimal analgesia regimen in HPB surgery remains controversial. METHODS: Using a 2.5:1 randomization strategy, 140 patients were randomized to TEA (N = 106) or intravenous patient-controlled analgesia (N = 34). Patient-reported pain was measured on a Likert scale (0-10) at standard time intervals. Cumulative pain area under the curve was determined using the trapezoidal method. RESULTS: Between the study groups key demographic, comorbidity, clinical, and operative variables were equivalently distributed. The median area under the curve of the postoperative time 0- to 48-hour pain scores was lower in the TEA group (78.6 vs 105.2 pain-hours, P = 0.032) with a 35% reduction in patients experiencing ≥7/10 pain (43% vs 62%, P = 0.07). Patient-reported outcomes and total opiate use further supported the benefit of TEA on patient experience. Anesthesia-related events requiring change in analgesic therapy were comparable (12.2% vs 2.9%, respectively, P = 0.187). Grade 3 or higher surgical complications (6.6% vs 9.4%), median length of stay (6 days vs 6 days), readmission (1.9% vs 3.1%), and return to the operating room (0.9% vs 3.1%) were similar (all P > 0.05). There were no mortalities in either group. CONCLUSIONS: In major HPB surgery, TEA provides a superior patient experience through improved pain control and less narcotic use, without increased length of stay or complications. |
| [Mh] Termos MeSH primário: |
Analgesia Epidural
Analgesia Controlada pelo Paciente
Analgésicos/administração & dosagem
Hepatectomia
Dor Pós-Operatória/tratamento farmacológico
Pancreaticoduodenectomia
Cuidados Pós-Operatórios/métodos
|
| [Mh] Termos MeSH secundário: |
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Analgesia Epidural/métodos
Analgesia Controlada pelo Paciente/métodos
Analgésicos/uso terapêutico
Feminino
Seguimentos
Seres Humanos
Infusões Intravenosas
Masculino
Meia-Idade
Medidas de Resultados Relatados pelo Paciente
Estudos Prospectivos
Resultado do Tratamento
Adulto Jovem
|
| [Pt] Tipo de publicação: | COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL |
[Nm] Nome de substância:
| 0 (Analgesics) |
| [Em] Mês de entrada: | 1709 |
| [Cu] Atualização por classe: | 180127 |
[Lr] Data última revisão:
| 180127 |
| [Sb] Subgrupo de revista: | AIM; IM |
| [Da] Data de entrada para processamento: | 170727 |
| [Cl] Clinical Trial: | ClinicalTrial
|
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1097/SLA.0000000000002386 |
| |
|
|
