Kim Sioh, Seo Jeongwon, Jeon Younghoon
Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.
Curr Ther Res Clin Exp. 2010 Oct;71(5):298-308. doi: 10.1016/j.curtheres.2010.10.005.
Nausea and vomiting are frequent adverse effects of patient-controlled epidural analgesia (PCEA) with opioids.
This study was designed to assess the antiemetic effect of midazolam added to fentanyl-ropivacaine PCEA.
In a prospective, randomized, double-blind, controlled trial, smoking patients with gastric cancer undergoing elective subtotal gastrectomy were evenly allocated to 1 of 2 treatment groups to manage postoperative pain: 0.2% ropivacaine mixed with fentanyl 4 μg/mL and midazolam 0.2 mg/mL (test group) or 0.2% ropivacaine mixed with fentanyl 4 μg/mL (control group). The PCEA infusion was set to deliver 4 μL/h of the study solution, with a bolus of 2 mL per demand and a 15-minute lockout time. The incidence of postoperative nausea and vomiting (PONV), pain intensity, sedation score, usage of rescue analgesia and rescue antiemetic, respiratory depression, urinary retention, and pruritus were recorded at 2, 6, 12, 24, 48, and 72 hours after surgery. Total infused volume of PCEA at 72 hours after surgery was measured.
A total of 60 patients were approached and randomized to treatment. No patients were excluded by exclusion criteria and all enrolled patients completed this study. Incidence of nausea (7% vs 33%; P = 0.02) in the test group was significantly lower than in the control group. The overall frequency of PONV in the test group was significantly less than that of the control group (7% vs 40%; P = 0.006). In addition, the mean (SD) infused volume of PCEA in the test group was significantly lower than that in the control group (392.3 [68.9] vs 351.2 [49.8] mL; P = 0.01). However, there were no significant differences in pain intensity, usage of rescue antiemetics and rescue analgesics, and mild pruritus between groups. No patient reported moderate or severe sedation, respiratory depression, or hypoxemia. In addition, there were no severe adverse events.
Midazolam added to fentanyl-ropivacaine PCEA was associated with a significant reduction in the incidence of PONV compared with fentanyl-ropivacaine alone, and a significant decrease in the amount of PCEA administered without a significant increase in adverse events in these patients who underwent subtotal gastrectomy.
恶心和呕吐是阿片类药物用于患者自控硬膜外镇痛（PCEA）时常见的不良反应。
本研究旨在评估咪达唑仑添加至芬太尼-罗哌卡因PCEA中的止吐效果。
在一项前瞻性、随机、双盲、对照试验中，将择期行胃大部切除术的吸烟胃癌患者均匀分配至2个治疗组中的1组以管理术后疼痛：0.2%罗哌卡因与4μg/mL芬太尼和0.2mg/mL咪达唑仑混合（试验组）或0.2%罗哌卡因与4μg/mL芬太尼混合（对照组）。PCEA输注设定为以4μL/h的速度输注研究溶液，每次按需推注2mL，锁定时间为15分钟。记录术后2、6、12、24、48和72小时的术后恶心呕吐（PONV）发生率、疼痛强度、镇静评分、补救性镇痛药和补救性止吐药的使用情况、呼吸抑制、尿潴留和瘙痒情况。测量术后72小时PCEA的总输注量。
共纳入60例患者并随机分组接受治疗。无患者因排除标准被排除，所有入组患者均完成本研究。试验组恶心发生率（7%对33%；P=0.02）显著低于对照组。试验组PONV的总体发生率显著低于对照组（7%对40%；P=0.006）。此外，试验组PCEA的平均（标准差）输注量显著低于对照组（392.3[68.9]对351.2[49.8]mL；P=0.01）。然而，两组之间在疼痛强度、补救性止吐药和补救性镇痛药的使用情况以及轻度瘙痒方面无显著差异。无患者报告中度或重度镇静、呼吸抑制或低氧血症。此外，无严重不良事件发生。
与单独使用芬太尼-罗哌卡因相比，在芬太尼-罗哌卡因PCEA中添加咪达唑仑可使接受胃大部切除术的患者PONV发生率显著降低，且PCEA使用量显著减少，同时不良事件未显著增加。
