在接受腹腔镜或内镜手术的新生儿和婴儿中,无阿片类麻醉与阿片类麻醉的比较:一种随机对照试验
L Pfokreni1, Pradeep Kumar Bhatia2, Darshana Rathod2
1Department of Anaesthesiology and Critical Care, AIIMS Bhopal, Madhya Pradesh, India.
Saudi journal of anaesthesia
|September 25, 2025
概括
在婴儿中,使用芬太尼的阿片类麻醉剂提供了比使用胺的无阿片类麻醉剂更好的立即缓解疼痛. 这两种方法都确保了类似的安全性和恢复,允许临床选择.
科学领域:
- 麻醉学 麻醉学
- 儿科手术 儿科手术
- 疼痛管理 疼痛管理
背景情况:
- 腹腔镜手术后的术后疼痛带来了挑战,包括转移的肩部疼痛,内脏和切口疼痛.
- 虽然阿片类药物很常见,但可能会引起镇静和恶心等副作用,可能会延迟患者的康复.
- 无阿片类麻醉 (OFA) 提供了一个有希望的替代方案,利用非阿片类药物来减轻与阿片类药物相关的不良影响并改善恢复.
研究的目的:
- 为了比较基于阿片类药物的麻醉 (OA) 与无阿片类药物的麻醉 (OFA) 在治疗新生儿和接受腹腔镜或内镜手术的婴儿的术后疼痛的疗效.
- 在这个儿科群体中评估这两种麻醉方法的安全性和恢复概况.
主要方法:
- 进行了一项单中心,前性,随机对照试验,涉及新生儿和婴儿 (ASA 1和2).
- 参与者被随机分配,接受输静脉注射芬太尼的OA或胺的OFA.
- 手术后的疼痛主要是通过在麻醉后护理单位 (PACU) 的新生儿疼痛量表 (NIPS) 进行评估,而二次评估则在术后长达12小时.
主要成果:
- 与以阿片类药物为基础的麻醉 (OA) 组相比,无阿片类麻醉 (OFA) 组在PACU中显示出明显更高的NIPS得分.
- 在OFA组中,更大比例的患者在手术后的第一小时内经历了中度疼痛 (NIPS>4) (41.7%vs16.6%).
- 这两种麻醉方法都表现出可比的手术内稳定性,恢复时间和安全结果.
结论:
- 在新生儿和婴儿中,使用芬太尼的阿片类麻醉剂提供了优越的手术后立即止痛,而与使用凯胺的无阿片类麻醉剂相比.
- 既OA和OFA都是可行的选择,表现出类似的手术内稳定性,恢复和安全性,允许根据临床判断和患者需求进行选择.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
687
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...
687
Local Anesthetics: Clinical Application as Spinal Anesthesia
1.3K
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...
1.3K
Parenteral Anesthetics: Overview
602
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.
602
Opioid Analgesics: Synthetic and Semisynthetic Opioids
925
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...
925
General Anesthesia: Overview
583
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...
583
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
568
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
568


