Xiao Y, Wu L, Zhou Q, Xiong W, Duan X, Huang X
Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Anesthesiology, Cancer Institute and Hospital, National Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking, China.
Acta Anaesthesiol Scand. 2015 Oct;59(9):1194-203. doi: 10.1111/aas.12560. Epub 2015 Jun 4.
Tolerance to remifentanil during sevoflurane anesthesia may increase postoperative analgesic requirements. Low-dose naloxone not only has been shown to block the development of acute opioid tolerance but also to ameliorate undesired opioid-induced side effects. We hypothesized that naloxone prevents the acute opioid tolerance produced by a large dose of remifentanil, and reduces the incidence of opioid-induced side effects.
Seventy-two patients undergoing open colorectal surgery were randomly assigned to receive intraoperative remifentanil (1) small dose at 0.1 μg/kg/min; (2) large dose at 0.30 μg/kg/min; or (3) large dose at 0.30 μg/kg/min combined with low-dose naloxone at 0.25 μg/kg/h just after the induction. Cumulative morphine consumption, postoperative pain scores, incidence of opioid-related side effects, time to recovery of bowel function, and length of hospital stay were recorded.
Cumulative morphine consumption at 24 h after surgery was higher in the large-dose remifentanil group (28 ± 12 mg) compared with the small-dose remifentanil group (17 ± 12 mg), and large-dose remifentanil-naloxone group (18 ± 9 mg), (P < 0.001). The median time to return of bowel function was shorter in the large-dose remifentanil-naloxone group than the other two groups (P < 0.05). The median length of hospital stay was lower in the large-dose remifentanil-naloxone group (8 [interquartile range: 8-12] days) compared with the small-dose remifentanil group (12 [interquartile range: 9-15] days) and large-dose remifentanil group (12 [interquartile range: 10-13] days), (P < 0.001).
Naloxone infusion prevented the acute opioid tolerance, provided a quicker recovery of bowel function, and reduced the length of hospital stay after open colorectal surgery.
七氟醚麻醉期间对瑞芬太尼产生耐受性可能会增加术后镇痛需求。低剂量纳洛酮不仅已被证明可阻止急性阿片类药物耐受性的发展，还能改善阿片类药物引起的不良副作用。我们推测纳洛酮可预防大剂量瑞芬太尼产生的急性阿片类药物耐受性，并降低阿片类药物引起的副作用发生率。
72例行开放性结直肠手术的患者被随机分配接受术中瑞芬太尼：(1) 小剂量，0.1μg/kg/分钟；(2) 大剂量，0.30μg/kg/分钟；或(3) 大剂量，0.30μg/kg/分钟，诱导后即刻联合低剂量纳洛酮，0.25μg/kg/小时。记录累积吗啡消耗量、术后疼痛评分、阿片类药物相关副作用发生率、肠功能恢复时间和住院时间。
与小剂量瑞芬太尼组（17±12mg）和大剂量瑞芬太尼-纳洛酮组（18±9mg）相比，大剂量瑞芬太尼组术后24小时的累积吗啡消耗量更高（28±12mg），（P<0.001）。大剂量瑞芬太尼-纳洛酮组肠功能恢复的中位时间比其他两组短（P<0.05）。与小剂量瑞芬太尼组（12天[四分位间距：9-15天]）和大剂量瑞芬太尼组（12天[四分位间距：10-13天]）相比，大剂量瑞芬太尼-纳洛酮组的中位住院时间更低（8天[四分位间距：8-12天]），（P<0.001）。
输注纳洛酮可预防急性阿片类药物耐受性，使肠功能恢复更快，并缩短开放性结直肠手术后的住院时间。
