无阿片类药物与阿片类药物节约策略用于腹腔镜切除术期间的多式抗接:一个随机对照试验
Vincent Collange1, Jean Baptiste Berruet1, Frederic Aubrun1
1Department of Anesthesiology, Medipole Villeurbanne Hospital, Villeurbanne, France.
Anaesthesia, critical care & pain medicine
|October 11, 2024
概括
在腹腔镜切除术患者中,无阿片类药物麻醉 (OFA) 与阿片类药物节制麻醉 (OSA) 相比,没有减少术后阿片类药物的使用. 这两种策略都提供了类似的疼痛控制,但OFA有更多的胸肌梗塞事件.
科学领域:
- 麻醉学 麻醉学
- 手术疼痛管理手术疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 在减少术后阿片类药物消耗和确保足够的疼痛控制方面,无阿片类药物麻醉 (OFA) 与阿片类药物节制性麻醉 (OSA) 的疗效尚不清楚.
- 这项研究调查了与OSA相比,OFA是否降低了拉巴洛斯科普切除术后的阿片类药物需求.
研究的目的:
- 测试假设,OFA降低了手术后阿片类药物消费与OSA相比,在进行腹腔镜切除术的患者.
- 为了比较OFA和OSA组之间的疼痛评分,阿片类药物相关的不良事件和生活质量.
主要方法:
- 一个单中心,前性随机控制的优越性试验,涉及155名接受腹腔镜切除术的患者.
- 患者被分配到使用利多卡因/胺输注 (OFA) 的sevoflurane-dexmedetomidine麻醉或使用利多卡因输注 (OSA) 的sevoflurane-sufentanil麻醉.
- 两组都接受了多式抗接;主要结局是手术后48小时累积的阿片类药物消费 (口服吗啡等价物).
主要成果:
- 48小时后的术后阿片类药物消耗在OFA和OSA组之间没有显著差异 (中位数为9毫克对14毫克的OME,p=0.861).
- 关键的次要结果,包括疼痛评分和与阿片类药物相关的不良事件,在各组之间是相似的.
- 与OSA组相比,OFA组的胸肌梗塞发病率是OSA组的三倍.
结论:
- 与阿片类药物节约性麻醉相比,无阿片类药物的麻醉并没有减少手术后的阿片类药物的消耗,而这些患者接受了 laparoscopic colectomy 进行多式反受理.
- 虽然没有减少阿片类药物的使用,但OFA与白心风险增加有关.
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