Department of Anaesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, PR China.
Tianjin Research Institute of Anaesthesiology, Tianjin 300052, PR China.
Br J Anaesth. 2016 Oct;117(4):504-511. doi: 10.1093/bja/aew248. Epub 2016 Oct 17.
Several studies indicate that remifentanil exposure may engender opioid-induced hyperalgesia. Butorphanol and flurbiprofen axetil are proposed as adjunctive analgesics for postoperative pain control. This randomized double-blind controlled study was designed to investigate the antihyperalgesic effects of butorphanol combined with flurbiprofen axetil on opioid-induced hyperalgesia.
One hundred and twenty patients undergoing elective laparoscopic gynaecological surgery with sevoflurane anaesthesia were randomized to one of four groups, as follows: intraoperative sufentanil 0.30 µg kg (Group S); remifentanil 0.30 µg kg min (Group R); intraoperative remifentanil and pre-anaesthesia butorphanol 20 µg kg (Group B); or intraoperative remifentanil and pre-anaesthesia butorphanol 10 µg kg combined with flurbiprofen axetil 0.5 mg kg (Group BF). Sufentanil was used to control postoperative pain. The threshold and area of postoperative mechanical hyperalgesia were measured with Von Frey filaments. Pain intensity, sufentanil consumption, and side-effects were recorded for 24 h after surgery.
Compared with Group S, remifentanil anaesthesia increased the pain score, postoperative sufentanil consumption, and area of hyperalgesia [mean 49.9 (sd 8.6) vs 60.5 (10.0) cm, P<0.001] and reduced the hyperalgesia threshold on the dominant inner forearm [mean 89.5 (sd 23.4) vs 60.6 (22.6) g, P=0.004]. Compared with Group R, the pain score, sufentanil consumption, and area of hyperalgesia were reduced and hyperalgesia threshold was elevated likewise in Groups B and BF. However, the efficacy in Group BF was higher than in Group B (P=0.021).
The preoperative combination of butorphanol and flurbiprofen axetil effectively ameliorated opioid-induced hyperalgesia in patients undergoing laparoscopic gynaecological surgery under sevoflurane-remifentanil anaesthesia.
NCT02043366.
几项研究表明，瑞芬太尼的暴露可能会引起阿片类药物诱发的痛觉过敏。布托啡诺和氟比洛芬酯被提议作为辅助镇痛药物用于术后疼痛控制。本随机双盲对照研究旨在探讨布托啡诺联合氟比洛芬酯对阿片类药物诱发痛觉过敏的抗痛觉过敏作用。
选择 120 例在七氟醚麻醉下接受择期腹腔镜妇科手术的患者，随机分为四组：术中舒芬太尼 0.30μg/kg（S 组）；瑞芬太尼 0.30μg/kg/min（R 组）；术中瑞芬太尼和术前布托啡诺 20μg/kg（B 组）；或术中瑞芬太尼和术前布托啡诺 10μg/kg 联合氟比洛芬酯 0.5mg/kg（BF 组）。舒芬太尼用于控制术后疼痛。用 Von Frey 细丝测量术后机械性痛觉过敏的阈值和面积。记录术后 24 小时的疼痛强度、舒芬太尼用量和不良反应。
与 S 组相比，瑞芬太尼麻醉增加了疼痛评分、术后舒芬太尼用量和痛觉过敏面积[平均值 49.9（标准差 8.6）比 60.5（10.0）cm，P<0.001]，降低了主导内前臂痛觉过敏阈值[平均值 89.5（标准差 23.4）比 60.6（22.6）g，P=0.004]。与 R 组相比，B 组和 BF 组的疼痛评分、舒芬太尼用量、痛觉过敏面积降低，痛觉过敏阈值升高。然而，BF 组的疗效高于 B 组（P=0.021）。
术前联合布托啡诺和氟比洛芬酯可有效改善七氟醚-瑞芬太尼麻醉下腹腔镜妇科手术患者的阿片类药物诱发痛觉过敏。
NCT02043366。
