Akarsu Metehan, Tuncer Sema, Reisli Ruhiye, Otelcioğlu Seref
Department of Anesthesiology and Reanimation, Selçuk University Meram Faculty Of Medicine, Konya, Turkey.
Agri. 2012;24(1):15-22. doi: 10.5505/agri.2012.07078.
Intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain, opioid requirement and specifically periincisional hyperalgesia. The aim of this study was to investigate the effect of magnesium in preventing remifentanil-induced hyperalgesia.
This study was performed on 60 (ASA I-II) patients planned for abdominal hysterectomy. Sixty patients were randomized into two equal groups. Before anesthesia, saline solution was given to the patients in group I (control group), 50 mg/kg i.v. Magnesium in group II (magnesium group). Anesthesia was induced with 1 µg/kg remifentanil combined with 4-5 mg/kg thiopental and 0.5 mg/kg atracurium, maintained with 0.5 MAC sevoflurane and 0.4 µg/kg/min remifentanil in both groups. Sevoflurane concentration was titrated according to autonomic responses. Thirty minutes before the anticipated end of surgery, a 0.15 mg/kg bolus dose of morphine was intravenously. At the end of surgery, patients received tramadol i.v via a PCA device. Pain score, tramadol demand and delivery were assessed at 2, 4, 6, 12, 24 h after surgery. Total tramadol consumption were recorded for 24-48 h after surgery. Periincisional hyperalgesia was assessed by measuring pain threshold to pressure by using an algometer and electronic von Frey filaments before operation and at 28-48 h postoperatively.
The pain scores and cumulative tramadol consumption were significantly lower in the magnesium group compared with the control group (p<0.05). Pressure and mechanical pain threshold were significantly less at 24-48 h postoperatively in control group than magnesium group.
Magnesium administered preemptively reduced remifentanil-induced hyperalgesia.
术中输注瑞芬太尼会导致急性阿片类药物耐受，表现为术后疼痛加剧、阿片类药物需求量增加，尤其是切口周围痛觉过敏。本研究旨在探讨镁预防瑞芬太尼诱发痛觉过敏的作用。
本研究纳入60例（ASA I-II级）计划行腹式子宫切除术的患者。60例患者被随机分为两组，每组30例。麻醉前，I组（对照组）患者静脉输注生理盐水，II组（镁组）患者静脉输注50mg/kg镁。两组均采用1μg/kg瑞芬太尼联合4-5mg/kg硫喷妥钠和0.5mg/kg阿曲库铵诱导麻醉，并用0.5MAC七氟醚和0.4μg/kg/min瑞芬太尼维持麻醉。根据自主反应调整七氟醚浓度。预计手术结束前30分钟，静脉注射0.15mg/kg吗啡。手术结束时，患者通过PCA装置静脉输注曲马多。术后2、4、6、12、24小时评估疼痛评分、曲马多需求量及用量。记录术后24-48小时曲马多总消耗量。术前及术后28-48小时，使用压力痛觉计和电子von Frey细丝测量切口周围痛觉过敏，评估疼痛阈值。
与对照组相比，镁组的疼痛评分和曲马多累积消耗量显著降低（p<0.05）。术后24-48小时，对照组的压力和机械性疼痛阈值显著低于镁组。
预先给予镁可减轻瑞芬太尼诱发的痛觉过敏。
