Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.
Keserwan Medical Center, Keserwan, Jounieh, Lebanon.
Obes Surg. 2019 Dec;29(12):3800-3808. doi: 10.1007/s11695-019-04074-1.
Dexmedetomidine is an α receptor agonist with sedative and analgesic properties. During bariatric surgery, its use may reduce postoperative opioid requirements, reduce their side effects, and improve quality of recovery. The aim of this prospective randomized controlled trial was to compare the effect of dexmedetomidine bolus and infusion versus morphine bolus given prior to the end of laparoscopic bariatric surgery.
Sixty morbidly obese patients (BMI > 40 kg m) aged 18 to 60 years, undergoing laparoscopic sleeve gastrectomy, received morphine sulfate (bolus 0.08 mg kg followed by a saline infusion) (group M, n = 30) or dexmedetomidine (loading dose of 1 μg kg followed by 0.5 μg kg h) (group D, n = 30) 30 min before the end of surgery. Data collected included morphine consumption in the post-anesthesia care unit (PACU) (primary outcome) and at 24 h, pain intensity, nausea, heart rate, blood pressure, vomiting, sedation, and quality of recovery.
There was no significant difference in morphine consumption in the PACU (group D 12.2 ± 5.44 mg, group M 13.28 ± 6.64 mg, P = 0.54) or at 24 h (group D 40.67 ± 24.78 mg, group M 43.28 ± 27.79 mg, P = 0.75); when accounting for intraoperative morphine given group M had significantly higher morphine consumption when compared to group D (23.48 ± 6.22 mg vs. 12.22 ± 5.54 mg, respectively, P < 0.01). Group D patients had more cardiovascular stability.
Dexmedetomidine given prior to end of laparoscopic sleeve gastrectomy provides the same level of postoperative analgesia as morphine with better hemodynamic profile.
右美托咪定是一种具有镇静和镇痛作用的α受体激动剂。在减重手术中，它的使用可能会减少术后阿片类药物的需求，减少其副作用，并改善恢复质量。本前瞻性随机对照试验的目的是比较在腹腔镜减重手术结束前给予右美托咪定推注和输注与吗啡推注对术后镇痛的影响。
60 名肥胖患者（BMI>40 kg/m2），年龄 18 至 60 岁，行腹腔镜袖状胃切除术，在手术结束前 30 分钟分别接受硫酸吗啡（推注 0.08 mg/kg，随后给予生理盐水输注）（M 组，n=30）或右美托咪定（负荷剂量 1μg/kg，随后 0.5μg/kg/h 输注）（D 组，n=30）。收集的数据包括麻醉后护理单元（PACU）内（主要结局）和 24 小时吗啡的消耗量、疼痛强度、恶心、心率、血压、呕吐、镇静和恢复质量。
PACU 内吗啡消耗量无显著差异（D 组 12.2±5.44mg，M 组 13.28±6.64mg，P=0.54）或 24 小时时（D 组 40.67±24.78mg，M 组 43.28±27.79mg，P=0.75）；当考虑术中给予的吗啡时，与 D 组相比，M 组的吗啡消耗量显著更高（23.48±6.22mg 与 12.22±5.54mg，分别，P<0.01）。D 组患者的心血管稳定性更好。
腹腔镜袖状胃切除术结束前给予右美托咪定可提供与吗啡相同水平的术后镇痛，并具有更好的血液动力学特征。
