加巴喷丁与雷莫司琼联合用于预防妇科腹腔镜手术后恶心呕吐的前瞻性随机对照研究。
Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study.
作者信息
Kim Kyung Mi, Huh Jin, Lee Soo Kyung, Park Eun Young, Lee Jung Min, Kim Hyo Ju
机构信息
Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156 Baengnyeong-Ro, Chuncheon, Gangwon-Do, 200-722, Republic of Korea.
出版信息
BMC Anesthesiol. 2017 May 19;17(1):65. doi: 10.1186/s12871-017-0357-8.
BACKGROUND
As a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery.
METHODS
One hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0-2, 2-24 and 24-48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting.
RESULTS
The incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups.
CONCLUSIONS
The combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02617121 , registered November 25, 2015.
背景
加巴喷丁最初作为一种抗惊厥药物被引入，最近已证明其在各种临床环境中治疗恶心和呕吐有效。本研究比较了口服加巴喷丁、静脉注射雷莫司琼以及加巴喷丁联合雷莫司琼在接受腹腔镜妇科手术后基于芬太尼的患者自控镇痛患者中的止吐效果。
方法
132例在全身麻醉下接受腹腔镜妇科手术的患者被随机分为三组：G组在麻醉前1小时口服300mg加巴喷丁，R组在手术结束时静脉注射0.3mg雷莫司琼，GR组在麻醉前1小时口服300mg加巴喷丁且在手术结束时静脉注射0.3mg雷莫司琼。在术后0 - 2小时、2 - 24小时和24 - 48小时评估术后恶心、干呕、呕吐、使用急救止吐药物情况、疼痛、急救镇痛需求及不良反应。术后恶心和呕吐（PONV）定义为存在恶心、干呕或呕吐。
结果
GR组（26/40，65%）术后48小时内完全缓解（无PONV且未使用急救止吐药）的发生率显著高于G组（16/40，40%；P = 0.025）和R组（18/44，41%；P = 0.027），而G组和R组之间无显著差异（P = 0.932）。呕吐发作次数、急救止吐药使用情况、严重呕吐、急救镇痛药使用情况或任何不良反应的发生率在组间无显著差异。各组术后疼痛评分也相似。
结论
加巴喷丁与雷莫司琼联合使用在预防腹腔镜妇科手术后PONV方面优于单独使用任何一种药物。
试验注册
ClinicalTrials.gov NCT02617121，于2015年11月25日注册。
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