术前而非术后使用氟比洛芬酯可减轻腹腔镜妇科手术后瑞芬太尼诱发的痛觉过敏：一项前瞻性、随机、双盲试验
Preoperative But Not Postoperative Flurbiprofen Axetil Alleviates Remifentanil-induced Hyperalgesia After Laparoscopic Gynecological Surgery: A Prospective, Randomized, Double-blinded, Trial.
作者信息
Zhang Linlin, Shu Ruichen, Zhao Qi, Li Yize, Wang Chunyan, Wang Haiyun, Yu Yonghao, Wang Guolin
机构信息
*Tianjin Research Institute of Anesthesiology †Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, P.R. China.
出版信息
Clin J Pain. 2017 May;33(5):435-442. doi: 10.1097/AJP.0000000000000416.
BACKGROUND
Acute remifentanil exposure during intraoperative analgesia might enhance sensitivity to noxious stimuli and nociceptive responses to innocuous irritation. Cyclooxygenase inhibition was demonstrated to attenuate experimental remifentanil-induced hyperalgesia (RIH) in rodents and human volunteers. The study aimed to compare the effects of preoperative and postoperative flurbiprofen axetil (FA) on RIH after surgery.
MATERIALS AND METHODS
Ninety patients undergoing elective laparoscopic gynecologic surgery were randomly assigned to receive either intravenous placebo before anesthesia induction (Group C); or intravenous FA (1.0 mg/kg) before anesthesia induction (Group F1) or before skin closure (Group F2). Anesthesia consisted off sevoflurane and remifentanil (0.30 μg/kg/min). Postoperative pain was managed by sufentanil titration in the postanesthetic care unit, followed by sufentanil infusion via patient-controlled analgesia. Mechanical pain threshold (primary outcome), pain scores, sufentanil consumption, and side-effects were documented for 24 hours postoperatively.
RESULTS
Postoperative pain score in Group F1 was lower than Group C. Time of first postoperative sufentanil titration was prolonged in Group F1 than Group C (P=0.021). Cumulative sufentanil consumption in Group F1 was lower than Group C (P<0.001), with a mean difference of 8.75 (95% confidence interval, 5.21-12.29) μg. Mechanical pain threshold on the dominant inner forearm was more elevated in Group F1 than Group C (P=0.005), with a mean difference of 17.7 (95% confidence interval, 5.4-30.0) g. Normalized hyperalgesia area was decreased in Group F1 compared to Group C (P=0.007). No statistically significant difference was observed between Group F2 and Group C.
CONCLUSIONS
Preoperative FA reduces postoperative RIH in patients undergoing laparoscopic gynecologic surgery under sevoflurane-remifentanil anesthesia.
背景
术中镇痛期间急性暴露于瑞芬太尼可能会增强对伤害性刺激的敏感性以及对无害刺激的伤害性反应。在啮齿动物和人类志愿者中已证实，抑制环氧化酶可减轻实验性瑞芬太尼诱发的痛觉过敏（RIH）。本研究旨在比较术前和术后应用氟比洛芬酯（FA）对术后RIH的影响。
材料与方法
90例行择期腹腔镜妇科手术的患者被随机分为三组，分别在麻醉诱导前静脉注射安慰剂（C组）；或在麻醉诱导前静脉注射FA（1.0mg/kg）（F1组）或在皮肤缝合前静脉注射FA（1.0mg/kg）（F2组）。麻醉采用七氟醚和瑞芬太尼（0.30μg/kg/min）。术后疼痛在麻醉后护理单元通过舒芬太尼滴定法进行管理，随后通过患者自控镇痛进行舒芬太尼输注。记录术后24小时的机械性疼痛阈值（主要结局指标）、疼痛评分、舒芬太尼用量和副作用。
结果
F1组术后疼痛评分低于C组。F1组术后首次舒芬太尼滴定时间比C组延长（P = 0.021）。F1组舒芬太尼累计用量低于C组（P < 0.001），平均差值为8.75（95%置信区间，5.21 - 12.29）μg。F1组优势侧前臂内侧的机械性疼痛阈值比C组升高更明显（P = 0.005），平均差值为17.7（95%置信区间，5.4 - 30.0）g。与C组相比，F1组的痛觉过敏面积标准化值降低（P = 0.007）。F2组和C组之间未观察到统计学上的显著差异。
结论
术前应用FA可降低七氟醚 - 瑞芬太尼麻醉下行腹腔镜妇科手术患者术后的RIH。
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