Effects of analgesic strategies on postoperative acute or chronic pain,
delirium and complications in laparoscopic colorectal surgery
Abstract
Aims: Postoperative pain and complications are the main risk factors
against patients’ recovery after colorectal surgery, and the pain can
aggravate postoperative complications.This study aimed to investigate
the effects of various postoperative analgesic strategies on the
recovery after laparoscopic colorectal surgery. Methods: 400 patients
undergoing laparoscopic colorectal cancer surgery were recruited, 335
patients were included eventually and five groups were involved: PCEA
with ropivacaine in group ropivacaine, and PCIA with morphine,
nalbuphine, sufentanil, or flurbiprofen plus sufentanil in the other
four groups. The postoperative delirium (POD), postoperative pain,
stress, and complications were recorded. Results: The incidence of POD
and chronic postsurgical pain (CPSP) at 3 months or 6 months after
surgery were higher in group sufentanil (P=0.004, P=0.003 or P=0.003,
vs. group ropivacaine). The risks of movement-evoked pain (MEP) were
much higher in group nalbuphine, group sufentanil and group flurbiprofen
plus sufentanil (P=0.001, P﹤0.001, and P﹤0.001, vs. group ropivacaine
), but not in group morphine. There were no differences in cortisol and
ACTH levels in the 5 groups (P﹥0.05). The incidence of pruritus was
found significantly higher in group morphine than in the other groups
except group S (P ﹤0.005). CPSP and POD were associated with MEP ( P
﹤0.05). Conclusion: PCEA is the first choice for postoperative
analgesia in laparoscopic colorectal surgery, PCIA with morphine or
nalbuphine can be considered an alternative, but sufentanil or combined
with flubiprofen might not be a good choice.