Murphy Glenn S, Szokol Joseph W, Avram Michael J, Greenberg Steven B, Marymont Jesse H, Shear Torin, Parikh Kruti N, Patel Shivani S, Gupta Dhanesh K
From the Department of Anesthesiology, North-Shore University HealthSystem, Pritzker School of Medicine, University of Chicago, Chicago, Illinois (G.S.M., J.W.S., S.B.G., J.H.M., T.S., K.N.P., S.S.P.); and Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.J.A., D.K.G.).
Anesthesiology. 2015 May;122(5):1112-22. doi: 10.1097/ALN.0000000000000633.
The intensity of pain after cardiac surgery is often underestimated, and inadequate pain control may be associated with poorer quality of recovery. The aim of this investigation was to examine the effect of intraoperative methadone on postoperative analgesic requirements, pain scores, patient satisfaction, and clinical recovery.
Patients undergoing cardiac surgery with cardiopulmonary bypass (n = 156) were randomized to receive methadone (0.3 mg/kg) or fentanyl (12 μg/kg) intraoperatively. Postoperative analgesic requirements were recorded. Patients were assessed for pain at rest and with coughing 15 min and 2, 4, 8, 12, 24, 48, and 72 h after tracheal extubation. Patients were also evaluated for level of sedation, nausea, vomiting, itching, hypoventilation, and hypoxia at these times.
Postoperative morphine requirements during the first 24 h were reduced from a median of 10 mg in the fentanyl group to 6 mg in the methadone group (median difference [99% CI], -4 [-8 to -2] mg; P < 0.001). Reductions in pain scores with coughing were observed during the first 24 h after extubation; the level of pain with coughing at 12 h was reduced from a median of 6 in the fentanyl group to 4 in the methadone group (-2 [-3 to -1]; P < 0.001). Improvements in patient-perceived quality of pain management were described in the methadone group. The incidence of opioid-related adverse events was not increased in patients administered methadone.
Intraoperative methadone administration resulted in reduced postoperative morphine requirements, improved pain scores, and enhanced patient-perceived quality of pain management.
心脏手术后疼痛的强度常常被低估，而疼痛控制不佳可能与恢复质量较差有关。本研究的目的是探讨术中使用美沙酮对术后镇痛需求、疼痛评分、患者满意度及临床恢复的影响。
156例接受体外循环心脏手术的患者被随机分为术中接受美沙酮（0.3mg/kg）或芬太尼（12μg/kg）两组。记录术后镇痛需求。在气管拔管后15分钟以及2、4、8、12、24、48和72小时评估患者静息及咳嗽时的疼痛情况。同时在这些时间点评估患者的镇静程度、恶心、呕吐、瘙痒、通气不足及低氧情况。
术后24小时内吗啡需求量，芬太尼组中位数为10mg，美沙酮组降至6mg（中位数差值[99%CI]，-4[-8至-2]mg；P<0.001）。拔管后24小时内观察到咳嗽时疼痛评分降低；12小时时咳嗽引起的疼痛程度，芬太尼组中位数为6，美沙酮组降至4（-2[-3至-1]；P<0.001）。美沙酮组患者对疼痛管理质量的感知有所改善。接受美沙酮治疗的患者中阿片类药物相关不良事件的发生率未增加。
术中给予美沙酮可降低术后吗啡需求量，改善疼痛评分，并提高患者对疼痛管理质量的感知。
