在腹腔镜腹腔外科手术中混合的无阿片类药物麻醉方案和区域壁膜阻塞 - 一个随机对照试验
Giuseppe Accurso1, Dario Rampulla2, Mariaconcetta Cusenza3,2
1Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy. giuseppe.accurso@policlinico.pa.it.
使用区域阻塞和多模式止痛药的无阿片类麻醉 (OFA) 显著减少疼痛,加快腹腔镜手术后的恢复. 与传统的阿片类药物治疗疼痛相比,这种方法改善了患者的治疗结果,减少了住院时间,并加强了早期动员.
科学领域:
- 麻醉学和疼痛管理
- 外科手术止痛疗法
- 区域麻醉技术 区域麻醉技术
背景情况:
- 越来越多地关注无阿片类麻醉 (OFA),以减轻手术患者的阿片类药物相关不良影响.
- 在腹腔镜腹腔外科手术中需要有效的疼痛管理策略,平衡有效性与安全性.
- 探索局部麻醉和多模式止痛药作为阿片类药物的替代品.
研究的目的:
- 评估OFA协议的疗效和安全性,用于手术内和术后的疼痛控制.
- 评估使用低剂量的硫酸,克洛尼丁和NSAIDs与TAP和RS阻断剂相结合的OFA.
- 在腹腔镜腹部手术中,将OFA协议与传统的阿片类药物止痛计划进行比较.
主要方法:
- 进行了一个单中心,未盲目的随机对照试验 (RCT).
- 参与者是成年患者,在全身麻醉下接受预定腹腔镜腹部手术.
- 这项研究将OFA组 (TAP阻断,RS阻断,低剂量硫酸,克洛尼丁,NSAID) 与接受常规阿片类止痛药的对照组进行了比较.
主要成果:
- 在所有时间点 (p < 0.001) 中,OFA 组的数值评分表 (NRS) 疼痛评分显著较低 (p < 0.001).
- 动员恢复时间在OFA组 (36.00 [18.00, 48.00] 小时) 与对照组 (48.00 [24.00, 72.00] 小时) 相比显著缩短 (p < 0.001).
- 停留时间 (LOS) 在OFA组减少 (4.00 [2.00, 6.00] 天) 与对照组 (6.00 [4.00, 9.00] 天) (p < 0.001),副作用较少,24小时内没有接受ICU治疗.
结论:
- 手术前的局部麻醉与OFA协议提供有效的手术内抗接和血液动力学稳定性.
- 该OFA协议显著减少了术后疼痛,缩短了康复时间,并减少了住院时间.
- 这种无阿片类药物的方法消除了与阿片类药物相关的副作用,促进了早期的患者动员,而不需要额外的药物.
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