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 (allP 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.
Citation：
MO Hong, ZHU Yuchun, HOU lin, YAN Zhengmin. Effectiveness and health economics evaluation of combined analgesia versus intermittent analgesia after retroperitoneal laparoscopy surgery: a retrospective cohort study
. Chinese Journal of Evidence-Based Medicine, 2018, 18(3): 263-266. doi: 10.7507/1672-2531.201801102
Copy
Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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Oza VP, Parmar V, Badheka J, et al. Comparative study of postoperative analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone after laparoscopic surgery. J Minim Access Surg, 2016, 12(3): 260-264.
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赵毅, 康福霞, 胡萍, 等. 泌尿外科后腹腔镜手术后患者疼痛原因的分析及护理. 解放军护理杂志, 2009, 26(3A): 57-58.
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Eslamian L, Jalili Z, Jamal A, et al. Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia. J Anesth, 2012, 26(3): 334-338.
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Rosen DM, Lam AM, Carlton MA, et al. Analgesia following major gynecological laparoscopic surgery-PCA versus intermittent intramuscular injection. JSLS, 1998, 2(1): 25-29.
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Pavlidis TE, Atmatzidis KS, Papaziogas BT, et al. The effect of preincisional periportal infiltration with ropivacaine in pain relief after laparoscopic procedures: a prospective, randomized controlled trial. JSLS, 2003, 7(4): 305-310.
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姜安丽. 新编护理学基础. 北京: 人民卫生出版社, 2013: 335.
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中华医学会麻醉学分会. 成人手术后疼痛处理专家共识. 临床麻醉学杂志, 2017, 33(9): 911-917.
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Chaibou MS, Sanoussi S, Sani R, et al. Management of postoperative pain: experience of the Niamey National Hospital, Niger. J Pain Res, 2012, 5: 591-595.
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Bruce J, Quinlan J. Chronic post surgical pain. Rev Pain, 2011, 5(3): 23-29.
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Dewinter G, Vande de Velde M, Fieuws S, et al. Transversus abdominis plane block versus perioperative intravenous lidocaine versus patient-controlled intravenous morphine for postoperative pain control after laparoscopic colorectal surgery: study protocol for a prospective, randomized, double-blind controlled clinical trial. Trials, 2014, 15: 476.
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Neal JM, Bernards CM, Butterworth JF 4th, et al. ASRA practice advisory on local anesthetic systemic toxicity. Region Anesth Pain Med, 2010, 35(2): 152-161.
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- 1. Oza VP, Parmar V, Badheka J, et al. Comparative study of postoperative analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone after laparoscopic surgery. J Minim Access Surg, 2016, 12(3): 260-264.
- 2. 赵毅, 康福霞, 胡萍, 等. 泌尿外科后腹腔镜手术后患者疼痛原因的分析及护理. 解放军护理杂志, 2009, 26(3A): 57-58.
- 3. Eslamian L, Jalili Z, Jamal A, et al. Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia. J Anesth, 2012, 26(3): 334-338.
- 4. Rosen DM, Lam AM, Carlton MA, et al. Analgesia following major gynecological laparoscopic surgery-PCA versus intermittent intramuscular injection. JSLS, 1998, 2(1): 25-29.
- 5. Pavlidis TE, Atmatzidis KS, Papaziogas BT, et al. The effect of preincisional periportal infiltration with ropivacaine in pain relief after laparoscopic procedures: a prospective, randomized controlled trial. JSLS, 2003, 7(4): 305-310.
- 6. 姜安丽. 新编护理学基础. 北京: 人民卫生出版社, 2013: 335.
- 7. 中华医学会麻醉学分会. 成人手术后疼痛处理专家共识. 临床麻醉学杂志, 2017, 33(9): 911-917.
- 8. Chaibou MS, Sanoussi S, Sani R, et al. Management of postoperative pain: experience of the Niamey National Hospital, Niger. J Pain Res, 2012, 5: 591-595.
- 9. Bruce J, Quinlan J. Chronic post surgical pain. Rev Pain, 2011, 5(3): 23-29.
- 10. Dewinter G, Vande de Velde M, Fieuws S, et al. Transversus abdominis plane block versus perioperative intravenous lidocaine versus patient-controlled intravenous morphine for postoperative pain control after laparoscopic colorectal surgery: study protocol for a prospective, randomized, double-blind controlled clinical trial. Trials, 2014, 15: 476.
- 11. Neal JM, Bernards CM, Butterworth JF 4th, et al. ASRA practice advisory on local anesthetic systemic toxicity. Region Anesth Pain Med, 2010, 35(2): 152-161.
