在视频辅助胸腔镜手术后,平衡的无阿片类药物麻醉治疗慢性术后疼痛:一个随机控制试验协议
Wen-Wen Huo1,2, Jia-Yu Qian1,3, Han-Xue Zhao1,2
1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Journal of pain research
|May 20, 2025
概括
无阿片类药物麻醉可以减少VATS后的慢性术后疼痛. 这项研究将无阿片类麻醉与基于阿片类麻醉进行比较,以评估慢性术后疼痛发生率和患者康复.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 胸部外科手术 胸部外科手术
背景情况:
- 阿片类药物是麻醉和缓解疼痛的标准药物,但具有诸如过敏症和慢性术后疼痛 (CPSP) 等风险.
- 视频辅助胸腔镜手术 (VATS) 患者容易感染CPSP.
- 将无阿片类麻醉 (OFA) 与阿片类麻醉 (OBA) 进行比较,对于改善患者的治疗结果至关重要.
研究的目的:
- 在接受VATS的患者中,比较OFA和OBA之间的CPSP发病率.
- 评估OFA与OBA对急性疼痛,不良事件和恢复质量的影响.
主要方法:
- 一项随机对照试验,涉及180名接受VATS肺切除的成年患者.
- 患者接受了OFA (德克斯梅德托米丁,埃斯基坦胺,塞沃弗兰) 或OBA (苏芬坦尼尔,塞沃弗兰).
- 多种模式的止痛包括勃起脊柱平面阻塞,flurbiprofen axetil和患者控制的sufentanil (对于OBA组).
主要成果:
- 主要结局:手术后3个月CPSP的发生率.
- 二级结局:急性疼痛评分,长期疼痛发生率,阿片类药物消费,不良事件和康复质量评分.
- 假设:与OBA相比,OFA将降低CPSP发生率并改善恢复.
结论:
- 该研究旨在确定OFA是否优于OBA在防止增值税后CPSP方面.
- 研究结果将为麻醉选择提供信息,以最大限度地减少长期疼痛并促进患者的康复.
- 这项研究有助于优化术后疼痛管理策略.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
201
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...
201
General Anesthesia: Overview
183
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
183
Local Anesthetics: Clinical Application as Epidural Anesthesia
404
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...
404
Analgesia and Pain Management
419
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...
419
Parenteral Anesthetics: Overview
91
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
91
Local Anesthetics: Clinical Application as Spinal Anesthesia
568
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...
568


