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无阿片类药物与基于阿片类药物的麻醉,用于白天手术,根据ERAS协议进行腹腔镜 inguinal hernia修复:一个随机的非劣势性试验

Chun Wang¹, Peng Shi¹, Jun Xu²

¹Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.

Hernia : the journal of hernias and abdominal wall surgery

|July 9, 2025

概括

无阿片类麻醉 (OFA) 提供与阿片类麻醉 (OA) 相比的缓解疼痛,用于腹腔镜手术. OFA提高了血液动力学稳定性,使其成为手术后增强恢复的有价值的替代方案.

科学领域:

麻醉学麻醉学
外科手术的结果
疼痛管理疼痛管理

背景情况:

腹腔镜 inguinal hernia修复 (LIHR) 越来越多地作为日间手术在手术后增强恢复 (ERAS) 协议下进行.
基于阿片类药物的麻醉 (OA) 是标准的,但可能会对术后恢复产生负面影响.
无阿片类麻醉 (OFA) 正在作为一种替代方法被探索.

研究的目的:

评估无阿片类麻醉 (OFA) 是否提供非劣质的术后疼痛控制与阿片类麻醉 (OA) 相比,日间手术 LIHR 在ERAS下.
评估与OFA相比OA相关的综合恢复结果.

主要方法:

一个随机控制的非劣势性试验,涉及90名接受日间手术的患者.
患者被分配给基于利多卡因-德克斯梅德托米丁的OFA (n=45) 或基于sufentanil-remifentanil的OA (n=45).
主要结局:24小时时间加权平均视觉模拟量表 (TWA-VAS) 休息时的疼痛评分. 二次结果包括恢复质量,途径效率和血液动力学.

主要成果:

在OFA (1.84±1.02) 和OA (1.77±0.88) 之间,在24小时TWA-VAS疼痛得分中建立了非劣势性.
在OFA组显示显著较低的手术内低血压 (8.9%对53.3%),但更长的气道移除和PACU停留时间.
在康复质量-15分,救援止痛,术后尿,恶心/吐或24小时排泄成功等方面没有发现显著差异.

结论:

基于利多卡因-德克斯梅德托米丁的OFA在ERAS协议中为日间手术LIHR提供了OA的非劣质止痛.
在手术过程中,OFA提供了卓越的血液动力稳定性.
OFA是白天手术LIHR的可行的替代麻醉策略,特别是对于容易受到阿片类药物相关不良影响的患者.

关键词:

昼间手术是日间手术.增强的复苏增强的复苏内 Hernia 是一个内.多种模式的止痛疗法.没有阿片类药物的麻醉.

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