Kassim Dina Y, Esmat Ibrahim M, Elgendy Mohammed A
Department of Anesthesia and Intensive Care, Beni Sweif University, Cairo, Egypt.
Department of Anesthesia and Intensive Care, Ain-Shams University, Cairo, Egypt.
Saudi J Anaesth. 2018 Jan-Mar;12(1):95-102. doi: 10.4103/sja.SJA_519_17.
Patients' surgical experiences are influenced by their perception of pain management. Duloxetine (Dulox) and dexamethasone (Dex) are used in multimodal analgesia to reduce opioid use and side effects. Dulox is a selective serotonin and norepinephrine reuptake inhibitor and has efficacy in chronic pain conditions. Dex enhances postoperative (PO) analgesia and reduces PO nausea and vomiting (PONV).
Seventy-five female patients were randomly allocated into one of three equal groups. GI received Dulox 60 mg orally and 100 ml 0.9% sodium chloride (normal saline [NS]) intravenous infusion (IVI) over 15 min, GII: received as GI except Dex 0.1 mg/kg was mixed with NS and GIII received identical placebo for Dulox capsule and Dex IVI, 2 h preoperatively. Patients' vitals, visual analog scale (VAS), and sedation score were assessed at 30 min, 1 h, 2 h, 6 h, and 12 h postoperatively. Total pethidine requirements, plasma cortisol, PONV, and patients satisfaction were recorded.
PO time for 1 rescue analgesic was significantly high in GI and GII compared to GIII and in GII compared to GI. There was a significant less VAS score, heart rate, mean arterial pressure, and a high sedation score in GI and GII compared to GIII at 30 min, 1, 2, and 6 h postoperatively. Total pethidine requirements were significantly less in GI and GII compared to GIII 12 h postoperatively. There was a significant reduction in the 2 h PO serum cortisol (μg/dl) and a significant increase in the PO patients satisfaction score in GI and GII compared to GIII. PONV was decreased significantly in GII compared to GI and GIII.
The use of oral Dulox 60 mg combined with Dex 0.1 mg/kg IVI is more effective than oral Dulox 60 mg alone, 2 h preoperatively, for improving PO pain by reducing the requirements for rescue analgesia and PONV.
患者的手术体验受其对疼痛管理的认知影响。度洛西汀（Dulox）和地塞米松（Dex）用于多模式镇痛以减少阿片类药物的使用及其副作用。度洛西汀是一种选择性5-羟色胺和去甲肾上腺素再摄取抑制剂，对慢性疼痛状况有效。地塞米松可增强术后镇痛并减少术后恶心和呕吐（PONV）。
75名女性患者被随机分为三个相等的组。第一组（GI）口服60毫克度洛西汀，并在15分钟内静脉输注（IVI）100毫升0.9%氯化钠（生理盐水[NS]）；第二组（GII）的用药与第一组相同，但将0.1毫克/千克地塞米松与生理盐水混合；第三组（GIII）在术前2小时接受度洛西汀胶囊和地塞米松静脉输注的相同安慰剂。在术后30分钟、1小时、2小时、6小时和12小时评估患者的生命体征、视觉模拟评分（VAS）和镇静评分。记录哌替啶的总需求量、血浆皮质醇、术后恶心呕吐情况及患者满意度。
与第三组相比，第一组和第二组使用1次急救镇痛药的术后时间显著更长，且第二组比第一组更长。与第三组相比，在术后30分钟、1小时、2小时和6小时，第一组和第二组的视觉模拟评分、心率、平均动脉压显著更低，镇静评分更高。术后12小时，与第三组相比，第一组和第二组的哌替啶总需求量显著更少。与第三组相比，第一组和第二组术后2小时的血清皮质醇（微克/分升）显著降低，术后患者满意度评分显著提高。与第一组和第三组相比，第二组的术后恶心呕吐情况显著减少。
术前2小时口服60毫克度洛西汀联合0.1毫克/千克地塞米松静脉输注在改善术后疼痛方面比单独口服60毫克度洛西汀更有效，可减少急救镇痛需求和术后恶心呕吐情况。
