Department of Anesthesiology, Federal Armed Forces Medical Centre Ulm, Ulm, Germany.
Anesthesiology. 2011 Aug;115(2):398-407. doi: 10.1097/ALN.0b013e318225cee5.
Both central sensitization after peripheral tissue injury and the development of opioid tolerance involve activation of N-methyl-D-aspartate (NMDA) receptors. At subanesthetic doses the NMDA receptor antagonist xenon suppresses pain-evoked sensitization of pain-processing areas in the central nervous system. Although numerous studies describe the effect of NMDA receptor antagonists on postoperative pain, clinical studies elucidating their intraoperative analgesic potency when applied in a low dosage are still largely missing.
To analyze the analgesic effect of low-dose xenon using new application methods, the authors tested nasally applied xenon as an add-on treatment for analgesia in 40 patients undergoing abdominal hysterectomy. Within a randomized double-blind placebo-controlled study design, intraoperative and postoperative requirement of opioids as well as postoperative subjective experiences of pain were measured as primary outcome variables.
Intranasal application of xenon significantly reduced intraoperative opioid requirement (mean difference [MD] -2.0 μg/min; 95% CI [CI95]-0.53 to -3.51, Bonferroni correction adjusted P value [pcorr]= 0.028) without relevant side effects and significantly reduced postoperative pain (MD -1.34 points on an 11-point rating scale; CI95 -0.60 to -2.09, pcorr = 0.002). However, postoperative morphine consumption (MD -8.8 μg/min; CI95 1.2 to -18.8, pcorr = 0.24) was not significantly reduced in this study.
Low-dose xenon significantly reduces intraoperative analgesic use and postoperative pain perception. Because NMDA receptor antagonists suppress central sensitization, prevent the development of opioid tolerance, and reduce postoperative pain, the intraoperative usage of NMDA receptor antagonists such as xenon is suggested to improve effectiveness of pain management within a concept of multimodal analgesia.
外周组织损伤后的中枢敏化和阿片类药物耐受的发展都涉及到 N-甲基-D-天冬氨酸（NMDA）受体的激活。亚麻醉剂量的 NMDA 受体拮抗剂氙气可抑制中枢神经系统中痛觉处理区域的痛觉诱发敏感化。尽管有许多研究描述了 NMDA 受体拮抗剂对术后疼痛的影响，但在低剂量应用时阐明其术中镇痛效力的临床研究仍在很大程度上缺失。
为了分析低剂量氙气的镇痛效果，作者使用新的应用方法测试了经鼻应用的氙气作为辅助镇痛剂在 40 例行腹部子宫切除术的患者中的作用。在一项随机、双盲、安慰剂对照研究设计中，将术中及术后阿片类药物的需求以及术后疼痛的主观体验作为主要观察变量。
经鼻应用氙气可显著减少术中阿片类药物的需求（平均差值[MD] -2.0 μg/min；95%置信区间[CI95] -0.53 至 -3.51，经 Bonferroni 校正的 P 值[pcorr] = 0.028），且无明显不良反应，并显著减轻术后疼痛（11 分评分量表上的 MD -1.34 分；95%CI -0.60 至 -2.09，pcorr = 0.002）。然而，在这项研究中，术后吗啡消耗量（MD -8.8 μg/min；95%CI 1.2 至 -18.8，pcorr = 0.24）并没有明显减少。
低剂量氙气可显著减少术中阿片类药物的使用和术后疼痛感知。由于 NMDA 受体拮抗剂可抑制中枢敏化、防止阿片类药物耐受的发展并减轻术后疼痛，因此建议在多模式镇痛的概念中术中使用 NMDA 受体拮抗剂，如氙气，以提高疼痛管理的效果。
