Faiz Seyed Hamid Reza, Seyed Siamdoust Seyed Alireza, Rahimzadeh Poupak, Houshmand Leila
Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.
Anesthesiology Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
J Pain Res. 2017 Sep 28;10:2311-2317. doi: 10.2147/JPR.S142186. eCollection 2017.
Some studies have shown that deeper anesthesia is more effective on postoperative analgesia and reduces the need for sedative drugs. This study sought to investigate the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy.
In this double-blind clinical trial, 60 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups: low bispectral index (L-BIS=35-44) and high bispectral index (H-BIS=45-55). Anesthesia protocol was the same for both groups (propofol and remifentanil). The pain intensity (at rest and during cough) was evaluated based on the visual analog scale scores in recovery and at 8, 16 and 24 hours after surgery.
The mean pain score was significantly lower in patients in the L-BIS group at all examined times at rest and during cough than that in the H-BIS group. The number of patients in need of additional sedative drug in the H-BIS group in recovery was significantly more than that in the L-BIS group (27 vs 18 patients, =0.007). The incidence of nausea in the recovery room 8 hours after the surgery was significantly less in the L-BIS group than that in the H-BIS group, while at 16 and 24 hours, no case of nausea was reported in the two groups.
Given the results of this study, it seems that general anesthesia with propofol and remifentanil with L-BIS causes less need for additional analgesic drug and less nausea and vomiting compared to anesthesia with H-BIS.
一些研究表明，深度麻醉对术后镇痛更有效，且可减少镇静药物的使用需求。本研究旨在探讨麻醉深度对腹腔镜胆囊切除术术后疼痛的影响。
在这项双盲临床试验中，60例行腹腔镜胆囊切除术的患者被随机分为两组：低脑电双频指数组（L-BIS = 35 - 44）和高脑电双频指数组（H-BIS = 45 - 55）。两组的麻醉方案相同（丙泊酚和瑞芬太尼）。根据视觉模拟量表评分，在恢复阶段以及术后8、16和24小时评估静息和咳嗽时的疼痛强度。
在所有检查时间点，L-BIS组患者静息和咳嗽时的平均疼痛评分均显著低于H-BIS组。恢复阶段H-BIS组中需要额外使用镇静药物的患者数量显著多于L-BIS组（27例对18例，P = 0.007）。术后8小时恢复室中L-BIS组恶心的发生率显著低于H-BIS组，而在16和24小时，两组均未报告恶心病例。
根据本研究结果，与采用H-BIS的麻醉相比，采用丙泊酚和瑞芬太尼并维持L-BIS的全身麻醉似乎需要更少的额外镇痛药物，且恶心和呕吐更少。
