多模式麻醉期间不使用阿片类药物与使用阿片类药物的策略对减肥手术术后吗啡消耗量的影响：随机双盲临床试验

BJA open Pub Date : 2024-02-23 DOI:10.1016/j.bjao.2024.100263

Matthieu Clanet , Karim Touihri , Celine El Haddad , Nicolas Goldsztejn , Jacques Himpens , Jean Francois Fils , Yann Gricourt , Philippe Van der Linden , Sean Coeckelenbergh , Alexandre Joosten , Anne-Catherine Dandrifosse

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引用次数: 0

摘要

背景减肥手术中无阿片类药物麻醉的有效性和安全性仍存在争议，尤其是在实施多模式镇痛时。由于多模式镇痛已成为许多中心的护理标准，我们旨在确定这种策略与右美托咪定（无阿片类药物麻醉）或吗啡过渡的瑞芬太尼（阿片类药物麻醉）相结合，是否能减少术后吗啡需求量和阿片类药物相关不良事件。方法在这项前瞻性双盲研究中，172 名接受腹腔镜胃旁路手术的 III 级肥胖患者被随机分配到接受七氟醚-右美托咪定麻醉并持续输注利多卡因和氯胺酮（无阿片类药物组）或接受七氟醚-瑞芬太尼麻醉并吗啡过渡（阿片类药物组）。两组患者在麻醉诱导时均注射了镁剂、利多卡因、氯胺酮、扑热息痛、双氯芬酸和地塞米松。主要结果是术后 24 小时的吗啡消耗量。次要结果包括术后恢复质量（QoR40）、低氧血症发生率、心动过缓以及术后恶心和呕吐（PONV）。术后吗啡消耗量无明显差异（中位数[四分位间范围]：16 [13-26] mg vs 15 [10-24] mg，P=0.183）。截至术后第30天的QoR40在各组之间没有差异，但无阿片类药物组的PONV发生率较低（37% vs 59%，P=0.005）。结论在减肥手术中，与基于阿片类药物的多模式麻醉策略相比，无阿片类药物的多模式麻醉技术并未减少术后吗啡消耗量。尽管不含阿片类药物组的 PONV 发生率较低，但各组的恢复质量并无差异。

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Effect of opioid-free versus opioid-based strategies during multimodal anaesthesia on postoperative morphine consumption after bariatric surgery: a randomised double-blind clinical trial

Background

The efficacy and safety of opioid-free anaesthesia during bariatric surgery remain debated, particularly when administering multimodal analgesia. As multimodal analgesia has become the standard of care in many centres, we aimed to determine if such a strategy coupled with either dexmedetomidine (opioid-free anaesthesia) or remifentanil with a morphine transition (opioid-based anaesthesia), would reduce postoperative morphine requirements and opioid-related adverse events.

Methods

In this prospective double-blind study, 172 class III obese patients having laparoscopic gastric bypass surgery were randomly allocated to receive either sevoflurane–dexmedetomidine anaesthesia with a continuous infusion of lidocaine and ketamine (opioid-free group) or sevoflurane–remifentanil anaesthesia with a morphine transition (opioid-based group). Both groups received at anaesthesia induction a bolus of magnesium, lidocaine, ketamine, paracetamol, diclofenac, and dexamethasone. The primary outcome was 24-h postoperative morphine consumption. Secondary outcomes included postoperative quality of recovery (QoR40), incidence of hypoxaemia, bradycardia, and postoperative nausea and vomiting (PONV).

Results

Eighty-six patients were recruited in each group (predominantly women, 70% had obstructive sleep apnoea). There was no significant difference in postoperative morphine consumption (median [inter-quartile range]: 16 [13–26] vs 15 [10–24] mg, P=0.183). The QoR40 up to postoperative day 30 did not differ between groups, but PONV was less frequent in the opioid-free group (37% vs 59%, P=0.005). Hypoxaemia and bradycardia were not different between groups.

Conclusions

During bariatric surgery, a multimodal opioid-free anaesthesia technique did not decrease postoperative morphine consumption when compared with a multimodal opioid-based strategy. Quality of recovery did not differ between groups although the incidence of PONV was less in the opioid-free group.