用于日间妇科腹腔镜手术的术中美沙酮:双盲随机对照试验。

IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Anaesthesia and Intensive Care Pub Date : 2024-04-22 DOI:10.1177/0310057X231214551
Kyle W Green, Gordana Popovic, Luke Baitch
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引用次数: 0

摘要

日间手术的最佳镇痛效果对于病人的舒适度和及时出院至关重要。短效阿片类药物是现代麻醉中常用的镇痛药物,可使患者在手术后迅速恢复。反复使用短效阿片类药物会导致血浆浓度波动,从而使患者在镇痛和镇痛不足之间摇摆不定,前者可能会产生不良反应,后者则需要进行抢救性用药。美沙酮的独特药理学可在减少阿片类药物用量的情况下提供有效而持续的镇痛,从而减少潜在的不良反应。通过一项双盲随机对照试验,我们比较了日间妇科腹腔镜手术患者术中静脉注射美沙酮(10 毫克)或短效阿片类药物后在麻醉科的阿片类药物消耗量。主要结果是麻醉后护理病房的阿片类药物消耗量(以口服吗啡当量计)。次要结果包括阿片类药物总消耗量、出院时阿片类药物消耗量、出院前疼痛评分(0-10)、不良反应(呼吸抑制、术后恶心呕吐、过度镇静)和入院率。七十名患者被随机分配。与短效组相比(分别为 18.02 毫克对 27.46 毫克,95% 置信区间为 0.003 至 18.88,P = 0.050),接受美沙酮治疗的患者在麻醉后护理病房平均少消耗 9.44 毫克口服吗啡当量,并且在每个时间点的术后疼痛评分都较低,但绝对差异很小。没有证据表明住院或出院时阿片类药物消耗量降低。美沙酮组和短效组在其他结果上无明显差异:呼吸抑制 41.2% 对 31.4%,Padjusted >0.99;术后恶心呕吐 29.4% 对 42.9%,Padjusted >0.99;入院过夜 17.7% 对 11.4%,Padjusted >0.99;过度镇静 8.82% 对 8.57%,Padjusted >0.99。这项研究提供的证据表明,美沙酮可以减少麻醉后监护室阿片类药物的消耗量和日间妇科腹腔镜手术后的术后疼痛评分,但幅度不大。任何次要结果均无明显差异。
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Intraoperative methadone for day-case gynaecological laparoscopy: A double-blind, randomised controlled trial.
Optimal pain relief in day-case surgery is imperative to patient comfort and timely discharge from hospital. Short-acting opioids are commonly used for analgesia in modern anaesthesia, allowing rapid recovery after surgery. Plasma concentration fluctuations from repeated dosing of short-acting opioids can cause patients to oscillate between analgesia with potential adverse effects, and inadequate analgesia requiring rescue dosing. Methadone's unique pharmacology may offer effective and sustained analgesia with less opioid consumption, potentially reducing adverse effects. Using a double-blind, randomised controlled trial, we compared post-anaesthesia care unit opioid consumption between day-case gynaecological laparoscopy patients who received either intravenous methadone (10 mg), or short-acting opioids intraoperatively. The primary outcome was post-anaesthesia care unit opioid consumption in oral morphine equivalents. Secondary outcomes included total opioid consumption, discharge opioid consumption, pain scores (0-10) until discharge, adverse effects (respiratory depression, postoperative nausea and vomiting, excess sedation), and rate of admission. Seventy patients were randomly assigned. Patients who received methadone consumed on average 9.44 mg fewer oral morphine equivalents in the post-anaesthesia care unit than the short-acting group (18.02 mg vs 27.46 mg, respectively, 95% confidence interval 0.003 to 18.88, P = 0.050) and experienced lower postoperative pain scores at every time point, although absolute differences were small. There was no evidence of lower hospital or discharge opioid consumption. No significant differences between the methadone and short-acting groups in other outcomes were identified: respiratory depression 41.2% versus 31.4%, Padjusted >0.99; postoperative nausea and vomiting 29.4% versus 42.9%, Padjusted >0.99; overnight admission 17.7% versus 11.4%, Padjusted >0.99; excess sedation 8.82% versus 8.57%, Padjusted >0.99. This study provides evidence that, although modestly, methadone can reduce post-anaesthesia care unit opioid consumption and postoperative pain scores after day-case gynaecological laparoscopy. There were no significant differences in any secondary outcomes.
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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
150
审稿时长
3 months
期刊介绍: Anaesthesia and Intensive Care is an international journal publishing timely, peer reviewed articles that have educational value and scientific merit for clinicians and researchers associated with anaesthesia, intensive care medicine, and pain medicine.
期刊最新文献
JG Farrell and The Lung: An early description of intensive care delirium in literature. Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review. MET call prevention. A cross-sectional study of the relationship between iron deficiency anaemia and chronic pain. Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney, Australia.
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