对接受青少年特发性脊柱侧弯手术的患者使用氨甲环酸会引起疼痛，并增加手术期间瑞芬太尼的输注速率。
Administration of tranexamic acid to patients undergoing surgery for adolescent idiopathic scoliosis evokes pain and increases the infusion rate of remifentanil during the surgery.
作者信息
Ohashi Nobuko, Ohashi Masayuki, Endo Naoto, Kohno Tatsuro
机构信息
Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata City, Japan.
Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata City, Japan.
出版信息
PLoS One. 2017 Mar 10;12(3):e0173622. doi: 10.1371/journal.pone.0173622. eCollection 2017.
BACKGROUND
We recently reported that tranexamic acid (TXA) evokes pain in rats by inhibiting γ-aminobutyric acid and glycine receptors on neurons in the spinal dorsal horn. Although TXA is commonly used to reduce perioperative blood loss during various surgeries, its potential to induce intraoperative nociception, thereby increasing the need for more analgesics during surgery, has not been investigated. Therefore, this study aimed to investigate whether TXA evokes pain and increases the need for a higher infusion rate of remifentanil in patients undergoing surgery for adolescent idiopathic scoliosis (AIS).
METHODS
Data were collected from patients with AIS who underwent posterior spinal fusion surgery from January 2008 to December 2015. All surgical procedures were performed under total intravenous anesthesia with propofol and remifentanil, by the same team of orthopedic surgeons and anesthesiologists at a single institution. Patients in the TXA group were administered TXA (loading and maintenance doses, 1000 mg and 100 mg/h) whereas those in the control group were not. Our primary outcome was the infusion rate of the intraoperative opioid analgesic remifentanil.
RESULTS
The final analysis was based on data collected from 33 and 30 patients in the control and TXA groups, respectively. No differences were observed in the demographic data or the hemodynamic parameters between the two groups of patients. In the TXA group, the durations of surgery and anesthesia were shorter, intravascular fluid volume and total blood loss were lower, and the doses of fentanyl and ketamine administered were higher than they were in the control group (P < 0.05 for all). The mean infusion rate of intraoperative remifentanil was significantly higher in the TXA group than in the control group (control group: 0.23 ± 0.04 μg/kg/min; TXA group: 0.28 ± 0.12 μg/kg/min; P = 0.014).
CONCLUSIONS
Patients who received TXA during the AIS surgery required a higher infusion rate of remifentanil, indicating that TXA evoked pain during the surgery.
背景
我们最近报道，氨甲环酸（TXA）通过抑制脊髓背角神经元上的γ-氨基丁酸和甘氨酸受体在大鼠中引发疼痛。尽管TXA常用于减少各种手术期间的围手术期失血，但其诱导术中伤害感受的可能性，从而增加手术期间对更多镇痛药的需求，尚未得到研究。因此，本研究旨在调查TXA是否会引发疼痛并增加青少年特发性脊柱侧凸（AIS）手术患者瑞芬太尼更高输注速率的需求。
方法
收集2008年1月至2015年12月接受后路脊柱融合手术的AIS患者的数据。所有手术均在单一机构由同一组骨科医生和麻醉医生在丙泊酚和瑞芬太尼全静脉麻醉下进行。TXA组患者给予TXA（负荷剂量和维持剂量分别为1000 mg和100 mg/h），而对照组患者未给予。我们的主要结局是术中阿片类镇痛药瑞芬太尼的输注速率。
结果
最终分析基于分别从对照组和TXA组的33例和30例患者收集的数据。两组患者的人口统计学数据或血流动力学参数均未观察到差异。在TXA组中，手术和麻醉持续时间较短，血管内容量和总失血量较低，芬太尼和氯胺酮的给药剂量高于对照组（所有P<0.05）。TXA组术中瑞芬太尼的平均输注速率显著高于对照组（对照组：0.23±0.04μg/kg/min；TXA组：0.28±0.12μg/kg/min；P = 0.014）。
结论
在AIS手术期间接受TXA的患者需要更高的瑞芬太尼输注速率，表明TXA在手术期间引发了疼痛。
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