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对于全内镜腰椎间盘切除术的内摩啡镇痛:一项前性剂量确定研究

Yue Lei¹, Zhang Feng¹, Wang Ziqi¹

¹Peking University First Hospital, Beijing, China.

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

|June 21, 2025

概括

在全内镜腰椎切除术 (FELD) 期间,内吗啡 (ITM) 有效地控制了手术内疼痛. 90%患者的最佳ITM剂量约为90.89μg,但更高的剂量可能会增加诸如之类的副作用.

科学领域:

麻醉学麻醉学
神经外科神经外科
药理学药理学是指药理学的学科.

背景情况:

对于全内镜腰椎间盘切除术 (FELD) 的局部或区域麻醉通常无法充分控制外科手术期间的疼痛.
内吗啡 (ITM) 是FELD疼痛管理的潜在辅助剂,但存在对其不良事件 (AE) 的担忧.

研究的目的:

为了确定在脊髓麻醉下接受FELD的90%患者 (ED90) 中消除手术内疼痛所需的内吗啡 (ITM) 的有效剂量.
为了评估100μg剂量范围内的ITM的安全性概况.

主要方法:

一项前性,双盲,顺序分配剂量发现研究使用了有偏见的硬币上下方法,其中30名参与者接受了FELD.
根据手术内疼痛强度 (视觉模拟量表 - VAS) 和需要额外的止痛药,调整了ITM剂量 (25,50,75,100微克).
使用同位素回归估计ED90和95%的置信区间.

主要成果:

估计FELD的ITM的ED90为90.89μg (95%CI为80.05-149.23μg). 在FELD中,ITM的估计ED90为90.89μg (95%CI为80.05-149.23μg).
在15/16名100μg患者和11/13名75μg患者中,获得了令人满意的止痛效果 (VAS=0).
与ITM相关的不良事件发生在22/30名患者中;恶心/吐和是最常见的. 与较低剂量 (1/14) 相比,100μg ITM (7/16) 时的发生频率更高.

结论:

在全内镜腰椎间盘切除术 (FELD) 期间,内吗啡 (ITM) 有效地控制了手术内疼痛.
大约90.89μg的ITM剂量似乎是大多数患者有效控制疼痛的最佳剂量.
虽然较低的ITM剂量可以减少等副作用,但需要进一步的研究来确定最安全和最有效的剂量.

关键词:

止痛药止痛药是一种止痛药.内镜断层切除术 (endoscopic disccectomy) 是一种内镜断层切除术.在内注射吗啡.脊柱外科手术脊柱外科手术

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