Lin Wei-Lin, Lee Meei-Shyuan, Wong Chih-Shung, Chan Shun-Ming, Lai Hou-Chuan, Wu Zhi-Fu, Lu Chueng-He
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center.
School of Public Health, National Defense Medical Center.
Medicine (Baltimore). 2019 Mar;98(13):e15074. doi: 10.1097/MD.0000000000015074.
As reported, patients experience less postoperative pain after propofol-based total intravenous anesthesia (TIVA). In the present study, we investigated the postoperative analgesic effects between propofol-based TIVA and desflurane anesthesia after spine surgery.
Sixty patients were included who received (surgical time >180 minutes) lumbar spine surgery. Patients were randomly assigned to receive either TIVA (with target-controlled infusion) with propofol/fentanyl-based anesthesia (TIVA group) or desflurane/fentanyl-based anesthesia (DES group), titrated to maintain Bispectral Index values between 45 and 55. All patients received patient-controlled analgesia (PCA) with fentanyl for postoperative pain relief. Numeric pain rating scale (NRS) pain scores, postoperative fentanyl consumption, postoperative rescue tramadol use, and fentanyl-related side effects were recorded.
The TIVA group patients reported lower NRS pain scores during coughing on postoperative day 1 but not day 2 and 3 (P = .002, P = .133, P = .161, respectively). Less fentanyl consumption was observed on postoperative days 1 and 2, but not on day 3 (375 μg vs 485 μg, P = .032, 414 μg vs 572 μg, P = .033, and 421 μg vs 479 μg, P = .209, respectively), less cumulative fentanyl consumption at postoperative 48 hours (790 μg vs 1057 μg, P = .004) and 72 hours (1210 μg vs 1536 μg, P = .004), and total fentanyl consumption (1393 μg vs 1704 μg, P = .007) when compared with the DES group. No difference was found in rescue tramadol use and fentanyl-related side effects.
Patients anesthetized with propofol-based TIVA reported less pain during coughing and consumed less daily and total PCA fentanyl after lumbar spine surgery.
据报道，接受丙泊酚全凭静脉麻醉（TIVA）的患者术后疼痛较轻。在本研究中，我们调查了脊柱手术后丙泊酚TIVA与地氟烷麻醉之间的术后镇痛效果。
纳入60例接受腰椎手术（手术时间>180分钟）的患者。患者被随机分配接受丙泊酚/芬太尼为基础的TIVA（采用靶控输注）麻醉（TIVA组）或地氟烷/芬太尼为基础的麻醉（DES组），滴定维持脑电双频指数值在45至55之间。所有患者术后均接受芬太尼患者自控镇痛（PCA）以缓解疼痛。记录数字疼痛评分量表（NRS）疼痛评分、术后芬太尼消耗量、术后补救性曲马多使用情况以及芬太尼相关副作用。
TIVA组患者在术后第1天咳嗽时的NRS疼痛评分较低，但在第2天和第3天无差异（分别为P = 0.002、P = 0.133、P = 0.161）。术后第1天和第2天观察到芬太尼消耗量较少，但第3天无差异（分别为375μg对485μg，P = 0.032；414μg对572μg，P = 0.033；421μg对479μg，P = 0.209），术后48小时（790μg对1057μg，P = 0.004）和72小时（1210μg对1536μg，P = 0.004）的芬太尼累积消耗量较少，与DES组相比，芬太尼总消耗量也较少（1393μg对1704μg，P = 0.007）。在补救性曲马多使用情况和芬太尼相关副作用方面未发现差异。
接受丙泊酚TIVA麻醉的患者在腰椎手术后咳嗽时疼痛较轻，且每日和PCA芬太尼总消耗量较少。
