后腹腔镜手术患者术后采用联合镇痛与间断静脉镇痛的疗效及卫生经济学评价

Effectiveness and health economics evaluation of combined analgesia versus intermittent analgesia after retroperitoneal laparoscopy surgery: a retrospective cohort study

目的回顾性分析泌尿外科后腹腔镜手术患者采用联合镇痛与间断静脉镇痛的镇痛效果及成本-效果。方法采用回顾性队列研究设计,根据患者术后镇痛方式不同分为联合镇痛组(患者切口局部注射罗哌卡因联合术后间断静脉注射镇痛)和间断静脉镇痛组(患者术后间断静脉注射镇痛),收集患者术后2 h、4 h、6 h、12 h、24 h疼痛视觉评分(VAS)、术后非甾体类抗炎药(NSAIDs)使用情况、不良反应、术后费用等信息,分析两组的镇痛效果及成本-效果。结果共纳入80例患者,两组各40例。联合镇痛组术后2 h、4 h VAS评分明显低于间断静脉镇痛组(P值均<0.05),但两组术后6 h、12 h、24 h VAS评分差异无统计学意义;联合镇痛组的术后NSAIDs剂量明显少于间断静脉镇痛组,镇痛有效率明显高于间断静脉镇痛组(P值均<0.05)。两组在术后人均住院总费用及人均镇痛总费用方面差异无统计学意义(P值均>0.05),但联合镇痛组的成本-效果更佳。结论切口局部皮下注射盐酸罗哌卡因联合术后间断静脉注射帕瑞昔布钠的镇痛方法对减轻泌尿外科后腹腔镜手术患者术后4 h内疼痛有良好效果,可在不增加不良反应前提下减少术后NSAIDs使用剂量,且该方法的成本-效果更好,具有较好的经济学优势。

Objective To retrospectively analyze the analgesic effect and cost-effectiveness of combined analgesia versus intermittent analgesia for patients underwent retroperitoneal laparoscopic surgery. Methods We retrospectively collected clinical parameters and outcomes of analgesic effect from patients who underwent retroperitoneal laparoscopic surgery. Included patients were divided into two groups： local injection of ropivacaine combined with intermittent administration with analgesic via intravenous injection and intermittent administration with analgesic via intravenous injection only. Visual analogue scale （VAS） at different time points （2 h, 4 h, 6 h, 12 h, 24 h）, usage of postoperative non- steroidal anti-inflammatory drugs （NSAIDs）, adverse events, costs and other information were collected and assessed for further analysis of analgesic effect and cost-effectiveness. Results A total of 80 patients were enrolled in this study, each group consists of 40 patients. The results of this study found that VAS scores at 2 h and 4 h after operation in the combined analgesic group were significantly lower than that in the intermittent intravenous analgesia group （P〈0.05）, while there were no significant differences between the two groups in VAS scores at 6, 12 and 24 h after operation. The usage of NSAIDs were significantly lower in the combined group than intermittent group （P〈0.05）. The effective rate in the combined group was significantly higher than that in the intermittent group （P〈0.05）. The average cost of postoperative hospitalization and postoperative analgesic of the two groups were similar （all P values 〉0.05）, and cost-effectiveness evaluation of the combined analgesia group was better than that of intermittent group. Conclusion Compared to intermittent administration with analgesic via intravenous injection, subcutaneous injection of ropivacaine hydrochloride combined with intermittent intravenous injection of parecoxib in patients underwent retroperitoneal laparoscopic surgery significantly could alleviate patients＇ painful complaints and reduce the postoperative usage of NSAIDs without increasing adverse events. Furthermore, the combination strategy has a lower cost-effectiveness ratio than intermittent group, which represents economic advantages.