Kim Eun Mi, Jeon Joo Hyun, Chung Mi Hwa, Choi Eun Mi, Baek Seung Hwa, Jeon Pil Hyun, Lee Mi Hyeon
Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Int J Med Sci. 2017 May 5;14(6):570-577. doi: 10.7150/ijms.19021. eCollection 2017.
While recovery from remifentanil is fast due to its rapid metabolism, it can induce hyperalgesia by activation of N-methyl-D-aspartic acid (NMDA) receptors. Therefore, administration of NMDA receptor antagonists such as ketamine is effective in relieving hyperalgesia caused by remifentanil. A previous study showed that nefopam administration before anesthesia combined with low-dose remifentanil reduced pain and analgesic consumption during the immediate postoperative period. We hypothesized that intraoperative infusion of nefopam during laparoscopic cholecystectomy would be as effective as ketamine in controlling pain during the acute postoperative period after sevoflurane and remifentanil based anesthesia. Sixty patients scheduled to undergo laparoscopic cholecystectomy were randomly divided into three groups. General anesthesia was maintained with sevoflurane and effect-site target concentration of remifentanil (4 ng/ml) in all patients. An intravenous bolus of nefopam (0.3 mg/kg) was given, followed by continuous infusion (65 µg/kg/h) in Group N (n=20). An intravenous bolus of ketamine (0.3 mg/kg) was administered, followed by continuous infusion (180 µg/kg/h) in Group K (n=20), and Group C received a bolus and subsequent infusion of normal saline equal to the infusion received by Group K (n=20). We compared postoperative Visual Analogue Scale (VAS) scores and analgesic requirements over the first 8 postoperative hours between groups. The pain scores (VAS) and fentanyl requirements for 1 h after surgery were significantly lower in the nefopam and ketamine groups compared with the control group (p<0.05). There were no differences between the nefopam and ketamine groups. The three groups showed no differences in VAS scores and number of analgesic injections from 1 to 8 h after surgery. Intraoperative nefopam infusion during laparoscopic cholecystectomy reduced opioid requirements and pain scores (VAS) during the early postoperative period after remifentanil-based anesthesia.
尽管瑞芬太尼因其快速代谢而恢复迅速，但它可通过激活N-甲基-D-天冬氨酸（NMDA）受体诱导痛觉过敏。因此，给予氯胺酮等NMDA受体拮抗剂可有效缓解瑞芬太尼引起的痛觉过敏。先前的一项研究表明，麻醉前给予奈福泮并联合低剂量瑞芬太尼可减轻术后即刻的疼痛并减少镇痛药的用量。我们推测，在基于七氟烷和瑞芬太尼的麻醉下，腹腔镜胆囊切除术术中输注奈福泮在控制术后急性期疼痛方面与氯胺酮同样有效。60例计划行腹腔镜胆囊切除术的患者被随机分为三组。所有患者均用七氟烷维持全身麻醉，并将瑞芬太尼效应室靶浓度设定为4 ng/ml。N组（n = 20）静脉推注奈福泮（0.3 mg/kg），随后持续输注（65 μg/kg/h）。K组（n = 20）静脉推注氯胺酮（0.3 mg/kg），随后持续输注（180 μg/kg/h），C组（n = 20）推注并随后输注与K组等量的生理盐水。我们比较了三组术后8小时内的视觉模拟评分（VAS）和镇痛药需求。与对照组相比，奈福泮组和氯胺酮组术后疼痛评分（VAS）及术后1小时芬太尼需求量显著更低（p<0.05）。奈福泮组和氯胺酮组之间无差异。三组术后1至8小时的VAS评分和镇痛药注射次数无差异。腹腔镜胆囊切除术术中输注奈福泮可减少基于瑞芬太尼麻醉术后早期的阿片类药物需求量和疼痛评分（VAS）。
