脊髄融合手術中のメタドンの手術後のオピオイド需要への影響:ランダム化臨床試験
Camilla Gaarsdal Uhrbrand1,2, Nicolai Carlé1, Kestutis Valancius3
1Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Spine
|August 27, 2025
まとめ
メタドンの単一の手術用投与は,腰部融合手術後のオピオイドの必要性や痛みを軽減しませんでした. この研究では,メタドンとモルヒンのグループ間の痛みの管理において,有意な違いが見つかりませんでした.
科学分野:
- 麻酔科
- 整形 術
- 痛みの管理
背景:
- 脊髄融合手術はしばしば 劇的な手術後の痛みを引き起こします
- メタドンの長時間作用は 手術後の痛みの管理とオピオイドの消費の減少に役立つ戦略です
研究 の 目的:
- 手術後のオピオイドの需要と腰部融合手術を受けた患者の痛みの強さを,単一の手術中のメタドンの投与量によって減少させることができるかどうかを判断する.
- 術後痛みの制御のためのモルヒンの治療前と閉塞前におけるメタドンの有効性を比較する.
主な方法:
- ランダム化され,盲検試験で,腰部融合手術を受けた3つの成人の患者グループを対象とした.
- 切開前にはメタドン (0. 2 mg/ kg),閉塞前にはメタドン (0. 2 mg/ kg),閉塞前にはモルヒン (0. 2 mg/ kg) を投与した.
- 主要なアウトカムには,6時間および24時間の累積的なオピオイド需要 (口服用モルヒン相当量) が含まれており,次要なアウトカムには痛み,吐き気,鎮静,患者の満足度が評価されました.
主要な成果:
- 手術後の6時間および24時間のオピオイドの必要性は,すべての3つのグループ (METpre,METpost,MORpost) で比較可能でした.
- METpre群では48時間と72時間後に報告されたより低い痛みを除いて,疼痛の強度はグループによって似ていた.
- 副作用,麻酔後の治療時間,または患者の満足度の有意な違いは観察されなかった.
結論:
- 手術後のオピオイドの必要性は,腰部融合後のモルヒネと比較して,切開または閉塞前に投与されたメタドンの単一の手術内投与量では有意に減少しませんでした.
- メタドンは痛みの管理やオピオイドの軽減に 重要な効果を示さなかった.
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