腺苷输注对接受扁桃体切除术的成年患者瑞芬太尼诱导的急性阿片耐受和阿片诱导痛觉过敏的影响。
The effects of intraoperative adenosine infusion on acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil in adult patients undergoing tonsillectomy.
机构信息
Department of Anesthesiology and Pain Medicine, College of Medicine, Wonkwang University, Iksan, Korea.
出版信息
Korean J Pain. 2011 Mar;24(1):7-12. doi: 10.3344/kjp.2011.24.1.7. Epub 2011 Feb 25.
BACKGROUND
Adenosine has been shown to have a wide spectrum of unique pain-relieving effects in various clinical situations. The aim of this study was to investigate the effects of intraoperative adenosine infusion on acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil in adult patients undergoing tonsillectomy.
METHODS
For this study, ninety patients were randomly allocated into groups that receive either adenosine (adenosine group) or saline (remifentnail group) intravenously under remifentanil based anesthesia and saline (sevoflurane group) under sevoflurane anesthesia. The patients in adenosine group received adenosine at dose of 80 µg/kg/min, and those in remifentnail group and sevoflurane group received an equal volume of saline 10 minutes after the induction of anesthesia until the end of surgery. Intraoperative evaluation included time weighted mean remifentanil dose, and postoperative evaluations included degree of pain severity at 1, 6, 12, and 24 hours, time to first postoperative requirement, and analgesic dose required during 24 hours after operation.
RESULTS
Time weighted mean remifentanil dose during intraoperative period in adenosine group was significantly lower than that of remifentnail group (P = 0.00). The first postoperative analgesic were required earlier in remifentanil group than sevoflurane group or adenosine group (P = 0.00). Pethidine requirement during 24 hours in sevoflurane group and adenosine group was significantly lower than that of remifentnail group (P = 0.00). The visual analog scale scores for pain in sevoflurane group and adenosine group were significantly lower than those of remifentnail group for 12 hours after operation (P = 0.00). Incidence of hypotension (P = 0.024) and number of ephedrine administered (P = 0.011) in adenosine group were significantly higher than those of sevoflurane group.
CONCLUSIONS
The above results suggest that intraoperative adenosine infusion prevent acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil.
背景
腺嘌呤已被证明在各种临床情况下具有广泛的独特止痛作用。本研究旨在探讨术中腺嘌呤输注对接受扁桃体切除术的成年患者中瑞芬太尼诱导的急性阿片类药物耐受和阿片类药物诱发痛觉过敏的影响。
方法
在这项研究中，90 名患者随机分为接受瑞芬太尼基础麻醉下腺嘌呤（腺嘌呤组）或生理盐水（瑞芬太尼组）静脉输注以及七氟醚麻醉下生理盐水（七氟醚组）的组。腺嘌呤组患者给予 80μg/kg/min 的腺嘌呤，瑞芬太尼组和七氟醚组患者在麻醉诱导后 10 分钟给予等容量生理盐水，直至手术结束。术中评估包括瑞芬太尼时间加权平均剂量，术后评估包括术后 1、6、12 和 24 小时疼痛严重程度、首次术后需求时间和术后 24 小时内所需的镇痛剂量。
结果
腺嘌呤组术中时间加权平均瑞芬太尼剂量明显低于瑞芬太尼组（P = 0.00）。瑞芬太尼组患者比七氟醚组或腺嘌呤组更早需要首次术后镇痛（P = 0.00）。七氟醚组和腺嘌呤组在术后 24 小时内需要的哌替啶剂量明显低于瑞芬太尼组（P = 0.00）。术后 12 小时，七氟醚组和腺嘌呤组的视觉模拟评分法（VAS）疼痛评分明显低于瑞芬太尼组（P = 0.00）。腺嘌呤组低血压的发生率（P = 0.024）和肾上腺素用量（P = 0.011）明显高于七氟醚组。
结论
上述结果表明，术中腺嘌呤输注可预防瑞芬太尼诱导的急性阿片类药物耐受和阿片类药物诱发的痛觉过敏。
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