Effect Of Optimized Analgesia Regimen In The Enhanced Recovery After Hepatopancreatobiliary Surgery

Objective:To explore the effect of optimized analgesia on postoperative pain control and prognosis improvement in patients with hepatopancreatobiliary surgery,which will provide theoretical basis for the clinical practice of enhanced recovery after surgery(ERAS)in hospitals.Methods:A retrospective analysis was conducted in First People’s Hospital of Yunnan Province,in which 200 patients admitted to the department of hepatobiliary and pancreatic surgery from July 2018 to November 2018 were included in this trial according to the inclusion and exclusion criteria.The patients were grouped into two groups,namely the traditional analgesia group and the optimized analgesia group.Compared with the traditional analgesic group,the optimized analgesia group had clinical pharmacists involved in perioperative pain management.Moreover,the optimized analgesia group accepted the ERAS concept and optimized the perioperative analgesic regimen under the guidance of ERAS.The same type of surgery was performed by doctors which have comparable surgical technique,andtraditional analgesia regimen and optimized analgesia regimen were respectively performed for perioperative pain management.The observation indicators of this study were as follows:(1)pain score within 72 hours after surgery;(2)the dose of dizocine for postoperative pain control;(3)postoperative recovery;(4)postoperative adverse reactions and complications.Results:A total of 200 patients were enrolled in the study,followed by grouping into the laparoscopic cholecystectomy group(n = 140),the open cholecystectomy group(n = 22)and the open abdominal partial resection group(n = 38).1.There were 140 patients in the laparoscopic cholecystectomy group,including 78 cases of the optimized analgesia group and 62 cases of the traditional analgesia group.(1)Intraoperative condition:patients in both groups successfully completed the operation,and without perioperative deaths.(2)Compared with the traditional analgesic group,the pain score within 36 hours after surgery and the dose of dizocine is decreased in the optimized analgesia group.Moreover,the postoperative ventilation time and the hospital stay in the optimized analgesia group is significantly shorter than the traditional analgesia group by 1 day(P < 0.05).(3)Postoperative adverse reactions and complications:the incidence of nausea,vomiting,dizziness and lethargy in the optimized analgesia group issignificantly lower than the traditional analgesic group(P < 0.05).However,there is no significant difference in the incidence of postoperative pulmonary infection between two groups(P > 0.05).2.There were 22 patients in the open cholecystectomy group,including11 cases of the optimized analgesia group and 11 cases of the traditional analgesia group.(1)Intraoperative condition: patients in both groups successfully completed the operation,and without perioperative deaths.(2)Postoperative pain score: there is no significant difference in pain score within 72 hours after surgery between the optimized analgesia group and the traditional analgesia group(P > 0.05).(3)The dose of dizocine after surgery: compared with the traditional analgesic group,the dose of dizocine in the optimized analgesia group decreases without statistical difference(P > 0.05).(4)Postoperative recovery:compared with the traditional analgesic group,the postoperative ventilation time and the hospital stay in the optimized analgesia group is shorter than the traditional analgesia group without statistical difference(P > 0.05).(5)Postoperative adverse reactions and complications: there is no significant difference in the incidence of nausea,vomiting,dizziness,lethargy and postoperative pulmonary infection between two groups(P > 0.05).3.There were 38 patients in the open abdominal partial resection group(n = 38),including 11 cases of the optimized analgesia group and 27 casesof the traditional analgesia group.(1)Intraoperative condition: patients in both groups successfully completed the operation,and without perioperative deaths.(2)Postoperative pain score: Postoperative pain score:there is no significant difference in pain score within 72 hours after surgery between the optimized analgesia group and the traditional analgesia group(P > 0.05).(3)The dose of dizocine after surgery: compared with the traditional analgesic group,the dose of dizocine for postoperative pain control decreases significantly(P < 0.05).(4)Postoperative recovery:compared with the traditional analgesic group,the postoperative ventilation time and the hospital stay in the optimized analgesia group is shorter than the traditional analgesia group.Moreover,there is a statistical difference in postoperative ventilation time between two groups(P < 0.05).(5)Postoperative adverse reactions and complications: there is significant difference in the incidence of nausea,vomiting,dizziness and postoperative pulmonary infection between two groups(P < 0.05).However,there is no statistical difference in the incidence of lethargy(P > 0.05).Conclusion:Patients with hepatopancreatobiliary surgery will significantly benefit from the perioperative pain management.Clinical pharmacists have a professional advantages in perioperative pain management to control pain.Moreover,ERAS will effectively reduce surgical stress in patients with hepatopancreatobiliary surgery,reduce postoperative opioid consumptionand complications,promote gastrointestinal function recovery,and shorten the hospital stay.