预防性口服加巴喷丁对腹腔镜结肠直肠癌根治术患者术后镇痛的影响

The efficacy of preventive oral gabapentin on postoperative analgesia after laparoscopic radical resection of colorectal cancer

目的探索预防性服用加巴喷丁用于腹腔镜结肠直肠癌根治术术后镇痛和术后康复的影响。方法收集2019年5月至2019年10月中国人民解放军南部战区总医院普通外科择期进行腹腔镜结肠直肠癌根治术患者43例,男27例,女16例,肿瘤分期无差异,采用计算机随机数字法分为预防性口服加巴喷丁组(G组,n=21)和常规镇痛组(R组,n=22)。G组于手术前晚和麻醉诱导前2 h分别给予加巴喷丁胶囊600 mg口服+患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA),R组则仅给予PCIA。记录R组和G组患者术后不同时间点的VAS评分、阿片类药物消耗量、QoR-15评分、Ramsay镇静评分、术后恶心、PONV发生率、补救镇痛及镇吐发生率以及不良反应等,以及术中瑞芬太尼、丙泊酚用量与气管插管后心血管反应等。结果与R组相比,G组术后10 d内静息状态下和咳嗽状态下、术后9 d内运动状态下VAS评分降低(P<0.05);G组患者术后9 d内患者疼痛满意度评分及术后12 d内Qo R-15评分均较R组增高,差异均有统计学意义(P<0.05);G组术后阿片类药物总消耗量、术中瑞芬太尼消耗量、气管插管后的心血管反应、补救镇吐的发生率,均较R组降低,差异均有统计学意义(P<0.05)。结论术前预防性口服加巴喷丁可显著降低腹腔镜结肠直肠癌根治术患者出院前的VAS评分和术后阿片类药物总消耗量,并且提高患者镇痛满意度和术后康复质量。

Objective To observe the efficacy of preventive oral gabapentin on postoperative analgesia and recovery in patients undergoing laparoscopic radical resection of colorectal cancer.Methods 43 patients including 27 males and 16 females with colorectal cancer were collected in the Department of Anesthesiology,General Hospital of Southern Theater Command of PLA from May 2019 to October 2019,and randomly assigned into routine analgesia group(group R)and gabapentin group(group G).Group G patients received two doses(600 mg each)of gabapentin and PCIA orally the night before the operation and the morning of the operation,whereas group R patients received only PCI A.The VAS(visual analogue score),patient pain satisfaction,and postoperative opioids consumption before discharge,the 15-item quality of recovery(QoR-15),incidences of postoperative nausea and vomiting(PONV),Ramsay sedation score,intraoperative remifentanil and propofol consumption,and cardiovascular response during endotracheal intubation were all recorded at 1,2,3,4,6,12,24,48 and 72 hours after the operation.Results The VAS in group G were statistically lower than that in group R at rest and coughing 10 days after the operation,and on movement 9 days after the operation(P<0.05).Meanwhile,in group G,pain satisfaction scores were statistically higher than in group R at 9 days after surgery and QoR-15 scores at 12 days after surgery(P<0.05).Moreover,when compared to group R,group G had statistically lower postoperative total opioid use,intraoperative remifentanil consumption,cardiovascular response during endotracheal intubation,and incidences of remedial antiemetics(P<0.05).There was no significant difference in total propofol dosage between the two groups(P>0.05).Conclusions In colorectal cancer patients undergoing laparoscopic radical resection,preoperative prophylactic oral gabapentin can significantly reduce the VAS scores before discharge and the total consumption of opioids after surgery,and improve patient satisfaction with analgesia and postoperative rehabilitation quality.