Lenz H, Raeder J, Hoymork S C
Department of Anaesthesia, Faculty Division Ullevaal University Hospital, Ullevaal University Hospital, University of Oslo, Oslo, Norway.
Acta Anaesthesiol Scand. 2008 Jan;52(1):149-54. doi: 10.1111/j.1399-6576.2007.01471.x. Epub 2007 Nov 8.
Remifentanil's short-acting analgesic effect and the potential of producing hyperalgesia is a challenge to post-operative pain control. This study investigated whether pre-treating the patients with fentanyl before remifentanil-based anaesthesia could reduce post-operative pain or analgesic consumption.
One-hundred patients admitted for anterior cruciate ligament repair were included in a double-blind study. Propofol and remifentanil were used for general anaesthesia. Group Pre received fentanyl 1.5 microg/kg intravenously (IV) and Group Post placebo before the remifentanil infusion. At the end of surgery, Group Pre received 1.5 microg/kg and Group Post received 3.0 microg/kg. Patient-controlled analgesia with fentanyl was used as analgesic rescue medication during the first 4 h post-operatively. Oxycodone 5 mg orally was taken as needed during the subsequent 4-24-h period.
A mean dose of remifentanil 0.43 microg/kg/min was used for 90 min during surgery in both groups. There were no differences in the verbal rate scale (VRS) score or need of rescue analgesic medication between the groups during the first 4 h. Group Post had significantly less pain in the 4-24-h period after surgery, with a median VRS score of 'slight pain' vs. 'moderate pain' in Group Pre (P<0.05). The oxycodone consumption was similar in both groups.
Pre-treatment with fentanyl 1.5 microg/kg IV yielded no reduction in post-operative pain or analgesic consumption after 90 min of remifentanil-based anaesthesia with 0.43 microg/kg/min of remifentanil.
瑞芬太尼的短效镇痛作用以及产生痛觉过敏的可能性对术后疼痛控制构成挑战。本研究调查了在以瑞芬太尼为主的麻醉前用芬太尼预处理患者是否能减轻术后疼痛或减少镇痛药的用量。
100例拟行前交叉韧带修复术的患者纳入一项双盲研究。采用丙泊酚和瑞芬太尼进行全身麻醉。瑞芬太尼输注前，预治疗组静脉注射芬太尼1.5μg/kg，后治疗组注射安慰剂。手术结束时，预治疗组注射1.5μg/kg，后治疗组注射3.0μg/kg。术后前4小时使用芬太尼患者自控镇痛作为镇痛补救药物。在随后的4 - 24小时内按需口服5mg羟考酮。
两组患者手术期间均使用了平均剂量为0.43μg/kg/min的瑞芬太尼，持续90分钟。两组在前4小时的语言评定量表（VRS）评分或补救镇痛药物的需求方面无差异。后治疗组在术后4 - 24小时疼痛明显减轻，VRS评分中位数为“轻度疼痛”，而预治疗组为“中度疼痛”（P<0.05）。两组羟考酮的用量相似。
在以0.43μg/kg/min的瑞芬太尼进行90分钟的麻醉后，静脉注射1.5μg/kg芬太尼预处理并未减轻术后疼痛或减少镇痛药的用量。
