在 laparoscopic 胆囊切除术后,用于缓解疼痛的无阿片类药物麻醉:一项前性随机对照试验
Jun-Ma Yu1,2, Qing-Yu Tao2, Yan He2
1Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
Journal of pain research
|November 6, 2023
概括
无阿片类药物麻醉 (OFA) 减少了救援止痛药的需要,并缩短了腹腔镜胆囊切除术 (LC) 后首次浮的时间. 然而,与以阿片类药物为基础的麻醉 (OBA) 相比,OFA的方向恢复和LMA移除时间更长.
科学领域:
- 麻醉学 麻醉学
- 手术创新 在外科创新.
- 疼痛管理 疼痛管理
背景情况:
- 基于阿片类药物的麻醉 (OBA) 是腹腔镜胆固醇切除术 (LC) 的标准,但存在副作用和依赖的风险.
- 无阿片类麻醉 (OFA) 提供了一个旨在减轻阿片类药物相关并发症的替代方案.
- 比较OFA和OBA对于优化LC中的麻醉方案至关重要.
研究的目的:
- 在接受LC的患者中,比较OFA与OBA的疗效.
- 评估术后止痛药的需求,恢复时间和患者舒适度.
主要方法:
- 150名接受3端口LC的患者被随机分配给OFA (乙胺,德克斯梅托米丁,利多卡因) 或OBA (雷米芬坦尼尔).
- 两组都接受了局部麻醉的透.
- 主要结果:在24小时内消耗救援止痛药;次要结果:恢复指标,疼痛得分,PONV和满意度.
主要成果:
- 在OFA组中,救援止痛药消耗显著降低 (P < 0.001) 和首次浮的时间更快 (P = 0.029).
- OFA组的LMA移除时间 (P < 0.001) 和方向恢复时间 (P < 0.001) 显着更长.
- 在OFA组中观察到2小时和8小时较低的VAS疼痛得分 (P = 0.002,P = 0.001) 和LMA插入时心率较低 (P = 0.016).
结论:
- OFA可能会降低术后止痛需要和LC的疼痛强度.
- OFA可能会缩短第一次浮气的时间.
- 虽然OFA在疼痛控制方面有好处,但需要考虑LMA移除和定向的更长的恢复时间.
相关概念视频
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
95
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
95
Opioid Analgesics: Synthetic and Semisynthetic Opioids
310
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
310
Local Anesthetics: Clinical Application as Epidural Anesthesia
438
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
438
Analgesia and Pain Management
634
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
634
Local Anesthetics: Clinical Application as Spinal Anesthesia
646
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
646


