{"title":"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。","authors":"Wenjun Wang, Yanxin Chen, Guanzhu Li, Ying Chen, Jianwei Wu, Yongyong Shi, Min Zhong","doi":"10.2147/DDDT.S480700","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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], <i>P</i> = 0.001; 15.6% vs 5.0%, <i>P</i> = 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], <i>P</i> = 0.648; 2 [1 to 2] vs 2 [1 to 2], <i>P</i> = 0.418; 0 [1 to 1] vs 0 [1 to 1], <i>P</i> = 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], <i>P</i> < 0.01; 15.6% vs 42.5%, <i>P</i> < 0.01), However, the PSQI on POD30 were similar between groups (8.27±3.94 vs 8.37±3.89, <i>P</i> = 0.870).</p><p><strong>Conclusion: </strong>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.</p><p><strong>Trial registration number: </strong>ChiCTR2200060130.</p>","PeriodicalId":11290,"journal":{"name":"Drug Design, Development and Therapy","volume":"19 ","pages":"1971-1981"},"PeriodicalIF":5.1000,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920631/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Opioid-Sparing Effects of Intraoperative Esketamine Combined with Dexmedetomidine During Laparoscopic Major Abdominal Surgery: A Randomized Controlled Double-Blind Trial.\",\"authors\":\"Wenjun Wang, Yanxin Chen, Guanzhu Li, Ying Chen, Jianwei Wu, Yongyong Shi, Min Zhong\",\"doi\":\"10.2147/DDDT.S480700\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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], <i>P</i> = 0.001; 15.6% vs 5.0%, <i>P</i> = 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], <i>P</i> = 0.648; 2 [1 to 2] vs 2 [1 to 2], <i>P</i> = 0.418; 0 [1 to 1] vs 0 [1 to 1], <i>P</i> = 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], <i>P</i> < 0.01; 15.6% vs 42.5%, <i>P</i> < 0.01), However, the PSQI on POD30 were similar between groups (8.27±3.94 vs 8.37±3.89, <i>P</i> = 0.870).</p><p><strong>Conclusion: </strong>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.</p><p><strong>Trial registration number: </strong>ChiCTR2200060130.</p>\",\"PeriodicalId\":11290,\"journal\":{\"name\":\"Drug Design, Development and Therapy\",\"volume\":\"19 \",\"pages\":\"1971-1981\"},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2025-03-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920631/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Drug Design, Development and Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/DDDT.S480700\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MEDICINAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Drug Design, Development and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/DDDT.S480700","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CHEMISTRY, MEDICINAL","Score":null,"Total":0}
The Opioid-Sparing Effects of Intraoperative Esketamine Combined with Dexmedetomidine During Laparoscopic Major Abdominal Surgery: A Randomized Controlled Double-Blind Trial.
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.
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.
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