Xuerong Yu, Yuguang Huang, Xia Ju, Hailan Wang
Department of Anesthesiology, Peking Union Medical College Hospital, Shuaifuyuan No.1, Dongcheng District, Beijing, China.
Anesth Analg. 2008 Dec;107(6):2032-7. doi: 10.1213/ane.0b013e3181888061.
N-methyl-D-aspartate receptor antagonists and nonsteroidal anti-inflammatory drugs are believed to prevent opioid-induced hyperalgesia and/or acute opioid tolerance, which could cause an increase in postoperative opioid requirement. In this randomized, double-blind, placebo-controlled study, we investigated whether co-administration of ketamine or lornoxicam and fentanyl could prevent the increase of postoperative morphine requirement induced by fentanyl alone.
Ninety females undergoing total abdominal hysterectomy with spinal anesthesia were randomly assigned to six groups consisting of placebo (normal saline, C), fentanyl (three bolus of 1 microg x kg(-1), F), ketamine (infusion of 15 microg x kg(-1) x min(-1), K), ketamine and fentanyl (infusion of 15 microg x kg(-1) x min(-1) ketamine plus three bolus of 1 microg x kg(-1) fentanyl, FK), lornoxicam (one bolus of 8 mg, L), and lornoxicam and fentanyl (one bolus of 8 mg lornoxicam plus three bolus of 1 microg x kg(-1) fentanyl, FL). Cumulative morphine consumption, pain score, and adverse effects were recorded at 1, 3, 6, 12, 24, and 48 h postoperatively.
Cumulative morphine consumption in Group F was significantly more than that in Group C at 3, 6, and 12 h postoperatively (P < 0.05). Postoperative cumulative morphine consumption was similar in Groups C, K, FK, L, and FL. No differences in postoperative pain scores were observed among groups. More patients in Groups K and FK had hallucinations during and/or after surgery than those in Group C (P < 0.05).
Our data suggest that the increase of postoperative morphine requirements induced by intraoperative administration of fentanyl could be prevented by ketamine or lornoxicam.
N-甲基-D-天冬氨酸受体拮抗剂和非甾体抗炎药被认为可预防阿片类药物引起的痛觉过敏和/或急性阿片类药物耐受，这可能导致术后阿片类药物需求量增加。在这项随机、双盲、安慰剂对照研究中，我们调查了氯胺酮或氯诺昔康与芬太尼联合使用是否能预防单独使用芬太尼引起的术后吗啡需求量增加。
90例行脊髓麻醉下全腹子宫切除术的女性被随机分为六组，分别为安慰剂组（生理盐水，C组）、芬太尼组（三次推注1μg·kg-1，F组）、氯胺酮组（输注15μg·kg-1·min-1，K组）、氯胺酮与芬太尼组（输注15μg·kg-1·min-1氯胺酮加三次推注1μg·kg-1芬太尼，FK组）、氯诺昔康组（一次推注8mg，L组）以及氯诺昔康与芬太尼组（一次推注8mg氯诺昔康加三次推注1μg·kg-1芬太尼，FL组）。术后1、3、6、12、24和48小时记录累积吗啡消耗量、疼痛评分及不良反应。
术后3、6和12小时，F组的累积吗啡消耗量显著高于C组（P<0.05）。C组、K组、FK组、L组和FL组术后累积吗啡消耗量相似。各组术后疼痛评分无差异。与C组相比，K组和FK组更多患者在手术期间和/或术后出现幻觉（P<0.05）。
我们的数据表明，氯胺酮或氯诺昔康可预防术中使用芬太尼引起的术后吗啡需求量增加。
