Chen Jian-qing, Wu Zhen, Wen Lai-you, Miao Jian-zhong, Hu Yong-ming, Xue Ruiping
Department of Anesthesiology, The Affiliated Jiangyin Hospital of Nantong University, 163 Shoushan Road, Jiangyin, Jiangsu Province, China.
BMC Anesthesiol. 2015 May 6;15:70. doi: 10.1186/s12871-015-0046-4.
Although pre-emptive analgesia is commonly used for the management of postoperative pain in developed countries, no defined protocol has been carried out and widely practiced, especially in transabdominal hysterectomy. Keeping this in mind the present study aimed to investigate the effects of multimodal pre-emptive analgesia on pain management, stress response and inflammatory factors of patients undergoing transabdominal hysterectomy to find an optimized way of pre-emptive analgesia.
One hundred patients undergoing abdominal hysterectomy were randomly divided into four groups (Trial registration: ChiCTR-IPR-15005848). Group P1 was given intravenous flurbiprofen and epidural fentanyl + ketamine before surgery; Group P2 received intravenous flurbiprofen before surgery and epidural fentanyl + ketamine after surgery; Group P3 was given epidural fentanyl + ketamine before surgery and intravenous flurbiprofen after surgery; Patients in Group C received normal saline treatment.
Compared with control group, the first time to request additional analgesics after surgery were significantly later (P < 0.05), 24 h dosage of analgesia were significantly less (P < 0.05), VAS score at all time periods after surgery were significantly lower (P < 0.05) in Group P1, P2, or P3. At 12 h or 24 h after surgery, VAS score in Group P1 was significantly lower than that in group P2 or P3 (P < 0.05, P < 0.05). No significant adverse effects were found among the groups (P > 0.05). At 1 or 2 days after surgery, the levels of cortisol, glucose, and IL-6, TNF-α in group P1, P2, and P3 were significantly lower than those in group C (P < 0.05); while, the levels in group P2, P3 were significantly lower than those in group P1 (P < 0.05).
Multimodal pre-emptive analgesia could significantly lower VAS score, inhibit stress response, and reduce inflammatory response in patients undergoing transabdominal hysterectomy, which can be a rational strategy for pain control in future.
ChiCTR-IPR-15005848 on January 17, 2015.
尽管在发达国家，超前镇痛常用于术后疼痛管理，但尚未有明确的方案得以实施并广泛应用，尤其是在经腹子宫切除术中。鉴于此，本研究旨在探讨多模式超前镇痛对经腹子宫切除术患者疼痛管理、应激反应及炎症因子的影响，以寻找优化的超前镇痛方法。
100例行腹部子宫切除术的患者被随机分为四组（试验注册号：ChiCTR - IPR - 15005848）。P1组在手术前静脉注射氟比洛芬并硬膜外注射芬太尼 + 氯胺酮；P2组在手术前静脉注射氟比洛芬，手术后硬膜外注射芬太尼 + 氯胺酮；P3组在手术前硬膜外注射芬太尼 + 氯胺酮，手术后静脉注射氟比洛芬；C组患者接受生理盐水治疗。
与对照组相比，P1、P2或P3组患者术后首次要求追加镇痛药的时间显著延迟（P < 0.05），24小时镇痛剂量显著减少（P < 0.05），术后各时间段的视觉模拟评分（VAS）均显著降低（P < 0.05）。术后12小时或24小时，P1组的VAS评分显著低于P2或P3组（P < 0.05，P < 0.05）。各组间未发现明显不良反应（P > 0.05）。术后1或2天，P1、P2和P3组的皮质醇、血糖以及白细胞介素 - 6（IL - 6）、肿瘤坏死因子 - α（TNF - α）水平均显著低于C组（P < 0.05）；而P2、P3组的水平显著低于P1组（P < 0.05）。
多模式超前镇痛可显著降低经腹子宫切除术患者的VAS评分，抑制应激反应，减轻炎症反应，可为未来疼痛控制提供合理策略。
2015年1月17日注册的ChiCTR - IPR - 15005848
