摘要：AimTo assess the effectiveness of epidural and systemic postoperative analgesia in laparoscopic urologic surgery.Patients and methodsRetrospective cohort of patients submitted to laparoscopic urological surgery: nephrectomy (LN) or prostatectomy (LP). Two protocols of analgesia for laparoscopy surgery were used: epidural Patient Controlled Analgesia of Ropivacaine and Fentanyl (epidural group) and subcutaneous-methadone and intravenous-NSAIDs (systemic group). The analgesic effectiveness at rest was evaluated at 24 and 48h as the worst pain intensity in the previous 24 hours (NRS: 0 to 10) for each evaluation. Rescue analgesia and presence of nausea/vomiting were also assessed.ResultsBetween January-2009 and December-2010, 414 consecutive patients were included: 290 LN (139 males, 151 females) and 124 LP. The median (sd) age was 61 (12) year-old.No differences were found respect to the mean (sd) of the worst pain intensity at 24 and 48 hours in LN population between epidural [1,1(1,1); 0,9(1,0)] and systemic [1,2(1,2); 1,2(1,1)] groups. In LP population similar results were observed [epidural: 1,0(0,8); 0,9(0,9); systemic: 0,8(1,1); 1,1(1,2)].With regard to rescue medication, no differences among populations were observed. The overall nausea/vomiting was lower than 5%.ConclusionOur results suggest that in laparoscopic urological surgery no differences in post-operative analgesia were observed between epidural PCA (Ropivacaine and Fentanyl) and systemic (combination of sc-methadone and iv-NSAIDs) groups. Epidural analgesia in laparoscopy urological surgery should be reconsidered.
关键词：epidural analgesia; systemic analgesia; laparoscopic urologic surgery
