The Opioid-Sparing Effects of Intraoperative Esketamine Combined with Dexmedetomidine During Laparoscopic Major Abdominal Surgery: A Randomized Controlled Double-Blind Trial.

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL Drug Design, Development and Therapy Pub Date : 2025-03-14 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S480700

Wenjun Wang, Yanxin Chen, Guanzhu Li, Ying Chen, Jianwei Wu, Yongyong Shi, Min Zhong

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Abstract

Background: Recently, opioid-sparing (OS) interventions have been proposed to facilitate rapid postoperative recovery for patients. However, the advantages of OS anesthesia strategy in laparoscopic abdominal major surgery are still unknown.

Methods: 157 patients undergoing laparoscopic major abdominal surgery were randomly assigned to two groups: Remi (77, remifentanil) and OS (80, esketamine combined with dexmedetomidine), the drugs were administered at 0.2-0.5 mg/kg/h (remifentanil or esketamine) and 0.2-0.7μg/kg/h (remifentanil or dexmedetomidine) in two syringes, respectively The primary outcome was the numeric rating scale (NRS) pain score on postoperative day (POD)1. The proportion of rescue analgesia within 48 h, extubation time, postoperative quality recover scale (PQRS), Pittsburgh Sleep Quality Index (PSQI) on POD30 were also recorded.

Results: In the postanaesthesia care unit (PACU), the NRS pain score and the proportion of rescue analgesia in Remi group was significantly higher than that in OS group (3 [1 to 3] vs 1 [1 to 3], P = 0.001; 15.6% vs 5.0%, P = 0.028, respectively), although there were no statistical differences in NRS pain score on POD1, POD7 and POD30 between groups (3 [2 to 3] vs 3 [2 to 3], P = 0.648; 2 [1 to 2] vs 2 [1 to 2], P = 0.418; 0 [1 to 1] vs 0 [1 to 1], P = 0.656, respectively). The extubation time in the OS group was longer and the proportion of dreaminess was also higher than that in the Remi group (20 [11 to 34] vs 31 [21 to 40], P < 0.01; 15.6% vs 42.5%, P < 0.01), However, the PSQI on POD30 were similar between groups (8.27±3.94 vs 8.37±3.89, P = 0.870).

Conclusion: In this study, OS anesthesia strategy during laparoscopic major abdominal surgery decreases the NRS pain scores in PACU and reduces the use of rescue analgesia, though it may prolong the extubation time and increase the proportion of dreaminess during hospitalization.

Trial registration number: ChiCTR2200060130.

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艾氯胺酮联合右美托咪定在腹腔镜腹部大手术中节省阿片类药物的作用：一项随机对照双盲试验。

背景：最近，阿片类药物节约（OS）干预措施被提出，以促进患者术后快速恢复。然而，OS麻醉策略在腹腔镜腹部大手术中的优势尚不清楚。方法：157例腹腔镜下腹部大手术患者随机分为Remi组（77例，瑞芬太尼）和OS组（80例，艾氯胺酮联合右美托咪定），分别以0.2 ~ 0.5 mg/kg/h（瑞芬太尼或艾氯胺酮）和0.2 ~ 0.7μg/kg/h（瑞芬太尼或右美托咪定）两支注射器给药，主要观察指标为术后第1天疼痛评分（NRS）。记录48 h内抢救镇痛比例、拔管时间、术后质量恢复量表（PQRS）、POD30匹兹堡睡眠质量指数（PSQI）。结果：在麻醉后护理单元（PACU）， Remi组NRS疼痛评分及抢救性镇痛比例显著高于OS组(3 [1 ~ 3]vs 1 [1 ~ 3], P = 0.001；15.6% vs 5.0%, P = 0.028)，但两组患者在POD1、POD7、POD30的NRS疼痛评分差异无统计学意义(3 [2 ~ 3]vs 3 [2 ~ 3], P = 0.648；2[1比2]vs 2[1比2]，P = 0.418；0[1比1]vs 0[1比1]，P = 0.656)。OS组拔管时间更长，做梦比例也高于Remi组(20例[11 ~ 34例]vs 31例[21 ~ 40例]，P < 0.01；（15.6%比42.5%,P < 0.01），但两组间PSQI比较，差异无统计学意义（8.27±3.94比8.37±3.89,P = 0.870）。结论：本研究中，腹腔镜腹部大手术时OS麻醉策略降低了PACU患者NRS疼痛评分，减少了抢救镇痛的使用，但可能延长拔管时间，增加住院期间的做梦比例。试验注册号：ChiCTR2200060130。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.