Hetta Diab Fuad, Fares Khaled Mohamed, Abedalmohsen Abualauon Mohamed, Abdel-Wahab Amani Hassan, Elfadl Ghada Mohammed Abo, Ali Wesam Nashat
Anesthesia and Pain Management, South Egypt Cancer Institute,
Anesthesia and Intensive Care, Faculty of Medicine, Assuit University, Assuit, Egypt.
J Pain Res. 2018 Oct 30;11:2675-2685. doi: 10.2147/JPR.S163975. eCollection 2018.
To assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery.
Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine (n=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/h of bupivacaine 0.1% + dexmedetomidine, 0.5 µg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS pain score were evaluated.
The cumulative morphine consumption was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs 23.23±8.37 mg with an estimated difference (95% CI) of -12.83 (-16.43, -9.24), (<0.001). The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, (<0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine : mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of -0.8 (-1, -0.86), (<0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference (95% CI) of -1.1 (-1.27, - 0.89), (<0.001), respectively.
Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.
评估在布比卡因输注液中添加右美托咪定用于接受腹部癌症大手术患者的术后镇痛效果。
计划接受上腹部癌症大手术的患者被分配至布比卡因组（n = 32），该组患者术后48小时接受硬膜外布比卡因输注（0.1%布比卡因6 mL/h），或布比卡因+右美托咪定组（n = 32），该组患者术后48小时接受在布比卡因输注液中添加右美托咪定（0.1%布比卡因6 mL/h + 右美托咪定0.5 μg/mL）。评估吗啡累积用量、首次镇痛需求时间和视觉模拟评分法（VAS）疼痛评分。
与布比卡因组相比，布比卡因+右美托咪定组的吗啡累积用量显著减少：平均值±标准差为10.40±5.16 mg，而布比卡因组为23.23±8.37 mg，估计差异（95%CI）为-12.83（-16.43，-9.24），（<0.001）。与布比卡因组相比，布比卡因+右美托咪定组首次镇痛需求时间显著延迟：中位数（四分位间距）为6（1.75，8.25）小时，而布比卡因组为1（0，4）小时，（<0.001）。与布比卡因组相比，布比卡因+右美托咪定组静息和活动时总体VAS疼痛评分随时间的平均下降幅度显著更大：平均值±标准误分别为1.6±0.08和2.38±0.08，估计差异（9/%CI）为-0.8（-1，-0.86），（<0.001），以及平均值±标准误分别为2.17±0.07和3.25±0.07，估计差异（95%CI）为-1.1（-1.27，-0.89），（<0.001）。
对于接受腹部癌症大手术的患者，在布比卡因硬膜外输注液中添加右美托咪定可显著减少吗啡用量，延迟首次补充镇痛的时间，并在术后48小时内降低疼痛强度，且对血流动力学无有害紊乱。
