Savitha Keelara Shivalingaiah, Dhanpal Radhika, Shilpa J
Department of Anaesthesia, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):473-477. doi: 10.4103/0259-1162.177520.
Multimodal analgesia (MMA) by synergy with volatile anesthetics minimizes their use thus decreasing operation theater pollution and greenhouse gas emission.
To estimate minimum alveolar concentration (MAC) requirement of isoflurane (ISO) for skin incision with use of MMA in the study group versus conventional regime in the control group for a constant bispectral index (BIS). To observe the side effects of analgesic drugs administered in the study.
Forty-two patients of American Society of Anesthesiologist Class I and II scheduled for lumbar spine surgery were included in this prospective, randomized, double-blind, clinical study. They were randomly allocated into two groups of 21 each.
Group A (MMA group/study group) received injections diclofenac sodium, paracetamol, clonidine, and fentanyl and local infiltration (bupivacaine with adrenaline). Group B (conventional regime group/control group) received injections paracetamol and fentanyl and local infiltration (saline with adrenaline). Preemptive analgesia was practiced in the study. The MAC of ISO for skin incision was documented.
Independent sample -test: To compare MAC for skin incision between the two groups. One sample -test: To compare the standard mean concentration with the means of the two groups. Chi-square test: To compare adverse effects between the groups. < 5% was considered statistically significant.
The MAC requirement was significantly lower in the study group at the time of skin incision for BIS of 50-55 compared to the control group ( < 0.001). Post extubation, 43% had nausea and 9% had vomiting in the control group. None of the patients in either group had intraoperative awareness.
We conclude that preemptive MMA has synergistic effect with ISO. It effectively reduces MAC to skin incision to a greater degree.
多模式镇痛（MMA）与挥发性麻醉剂协同作用可减少其使用量，从而降低手术室污染和温室气体排放。
在研究组中，通过多模式镇痛来估计异氟烷（ISO）用于皮肤切口时的最低肺泡浓度（MAC）需求，对照组采用传统方案，保持脑电双频指数（BIS）恒定。观察研究中使用的镇痛药物的副作用。
本前瞻性、随机、双盲临床研究纳入了42例美国麻醉医师协会I级和II级、计划行腰椎手术的患者。他们被随机分为两组，每组21例。
A组（MMA组/研究组）接受双氯芬酸钠、对乙酰氨基酚、可乐定和芬太尼注射以及局部浸润（布比卡因加肾上腺素）。B组（传统方案组/对照组）接受对乙酰氨基酚和芬太尼注射以及局部浸润（生理盐水加肾上腺素）。研究中采用了超前镇痛。记录ISO用于皮肤切口时的MAC。
独立样本t检验：比较两组皮肤切口的MAC。单样本t检验：比较标准平均浓度与两组的均值。卡方检验：比较两组间不良反应。P<0.05被认为具有统计学意义。
与对照组相比，研究组在BIS为50 - 55时皮肤切口时的MAC需求显著降低（P<0.001）。拔管后，对照组43%出现恶心，9%出现呕吐。两组患者术中均未出现知晓。
我们得出结论，超前多模式镇痛与异氟烷具有协同作用。它能更有效地将皮肤切口的MAC降低到更大程度。
