Background

Intrathecal morphine is a popular and effective regional technique for pain control after open liver resection, but its delayed analgesic onset makes it less useful for the intraoperative period. The aim of this retrospective study was to compare the analgesic efficacy and other secondary benefits of the addition of hyperbaric bupivacaine to intrathecal morphine +/- fentanyl. We hypothesized that bupivacaine could serve as an analgesic “bridge” prior to the onset of intrathecal morphine/fentanyl thereby lowering opioid consumption and enhancing recovery.

Methods

Cumulative intraoperative and postoperative opioid consumption as well as other intra- and postoperative variables were collected and compared between groups receiving intrathecal morphine alone or intrathecal morphine +/- hyperbaric bupivacaine.

Results

Sixty-eight patients were selected for inclusion. Cumulative intraoperative morphine consumption was significantly reduced in the bupivacaine group while other intraoperative parameters such as intravenous fluids, blood loss, and vasopressors did not differ. There was a statistically significant improvement in time to first bowel movement in the experimental group.

Discussion

The intraoperative opioid sparing effects and improved time to bowel function with the addition of hyperbaric bupivacaine to intrathecal morphine may make this technique an easy and low risk method of enhancing recovery after open liver resection.

中文翻译：

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评估在鞘内注射吗啡中加入布比卡因对开放性肝切除术中和术后疼痛的管理

背景

鞘内注射吗啡是一种流行且有效的区域性开放性肝切除术后疼痛控制技术，但其镇痛起效延迟使其在术中的用处不大。这项回顾性研究的目的是比较在鞘内注射吗啡 +/- 芬太尼后添加高压布比卡因的镇痛效果和其他次要益处。我们假设布比卡因可以在鞘内注射吗啡/芬太尼之前充当镇痛“桥梁”，从而降低阿片类药物的消耗并促进恢复。

方法

收集并比较单独接受鞘内注射吗啡或鞘内注射吗啡 +/- 高压布比卡因的组之间累积的术中和术后阿片类药物消耗量以及其他术中和术后变量。

结果

选择了 68 名患者纳入研究。布比卡因组术中累积的吗啡消耗量显着减少，而其他术中参数（如静脉输液、失血量和血管加压药）没有差异。实验组第一次排便的时间有统计学意义的改善。

讨论

在鞘内注射吗啡中添加高压布比卡因，术中阿片类药物的节省效应和改善肠道功能的时间可能使该技术成为一种简单且低风险的促进开放性肝切除术后恢复的方法。