腹腔内注射罗哌卡因可缩短晚期卵巢癌术后开始化疗的时间间隔:随机对照双盲试验研究
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study
背景与目的
晚期卵巢癌预后较差。标准的治疗方法是手术切除以避免肿瘤残留，然后辅以化疗。局部麻醉药(LA)具有抗炎镇痛作用。我们假设腹膜内注射局部麻醉药 (IPLA)可改善术后恢复，减轻疼痛，并尽早开始化疗。
方 法
本项前瞻性、随机、双盲、安慰剂对照初步研究，共纳入40名接受开腹肿瘤细胞减灭术的女性患者。患者在围术期随机接受罗哌卡因(IPLA组)或生理盐水(安慰剂组)用于腹腔注射。除了研究用的药物外，对患者的治疗均相似。术中腹腔内注射罗哌卡因2 mg ml-1或0.9%生理盐水3次，术后经导管和镇痛泵持续72h泵入腹腔。记录术后疼痛、恢复时间、出院时间、化疗开始时间及术后并发症。
结 果
IPLA组术后未见并发症发生。两组间疼痛强度与紧急镇痛用药量基本相似。IPLA组术后开始化疗的时间明显缩短(中位数21[四分位数范围21~29]天 vs 29[四分位范围21~40]天；P＝0.021)。两组间其他参数，包括居家准备时间、出院次数和发病率，以及术后并发症的复杂程度均相似。
结 论
卵巢癌肿瘤细胞减灭术中腹腔内注射罗哌卡因，以及术后腹腔内持续泵注罗哌卡因72小时是安全的，缩短了术后化疗开始的时间间隔。但有必要进行更大规模的研究来证实这些初步发现。
原始文献来源及摘要
Jane M. Hayden, Jonatan Oras, Linda Block, et al. Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study.[J].Br J Anaesth 2020 05;124(5).
Abstract
Background: Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.
Methods: This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml-1 or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded.
Results: No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [interquartile range 21－29] vs 29 [inter-quartile range 21－40] days; P＝0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups.
Conclusions: Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：佟睿 编辑：冯玉蓉 审校：曹莹