Zdravkovic Marko, Kamenik Mirt
Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia.
Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia.
J Clin Anesth. 2020 Apr 16;64:109808. doi: 10.1016/j.jclinane.2020.109808.
We aimed to determine the magnitude of peri-operative opioid sparing effect when general anesthesia is combined with spinal analgesia for laparoscopic gynecological surgery.
A prospective randomized controlled study; a three-group trial with two comparisons (each intervention group to control).
Operating room and postoperative recovery area.
Patients aged between 18 and 65 years with American Society of Anesthesiologists physical status 1 or 2 who were scheduled for inpatient elective laparoscopic gynecological surgery with expected pneumoperitoneum duration of at least 20 min. Of 102 randomized patients, 99 completed the study.
Patients were randomized to general anesthesia alone (control group) or combined with very-low-dose (levobupivacaine 3.75 mg; sufentanil 2.5 μg) or low-dose (levobupivacaine 7.5 mg; sufentanil 2.5 μg) spinal analgesia.
Primary endpoints were perioperative opioid consumption and pain scores (11-point numeric rating scale) at 30 min, 1 h, 2 h, 4 h and 24 h post-surgery. Secondary endpoints were patient satisfaction with anesthetic care and participation in research, sevoflurane consumption and adverse effects.
Intra-operative sufentanil (median [95% CI]) consumption was 16.1 (10.5-22.6) μg/h in the control group versus 4.7 (3.2-9.2) μg/h in the very-low-dose and versus 2.9 (0.0-4.0) μg/h in the low-dose spinal analgesia groups (p < 0.001, for both comparisons). Median (95% CI) piritramide consumption at 24 h post-surgery was 7.5 (3-8) mg in the control group versus 5 (0-7.5) mg in the very-low dose spinal analgesia group (p = 0.182) and versus 2 (0-2.5) mg in the low-dose spinal analgesia group (p = 0.001). Postoperative pain scores were consistently <3 only in the low dose spinal analgesia group. Patient satisfaction with anesthetic care and participation in research was very high in all groups.
Low-dose spinal analgesia in combination with general anesthesia reduces peri-operative opioid consumption in laparoscopic gynecological surgery in immediate postoperative period.
我们旨在确定全身麻醉联合脊髓镇痛用于腹腔镜妇科手术时围手术期阿片类药物节省效应的程度。
一项前瞻性随机对照研究；三组试验，进行两项比较（每个干预组与对照组比较）。
手术室和术后恢复区。
年龄在18至65岁之间、美国麻醉医师协会身体状况为1或2级、计划进行住院择期腹腔镜妇科手术且预计气腹持续时间至少20分钟的患者。102例随机分组的患者中，99例完成了研究。
患者被随机分为单纯全身麻醉组（对照组）或联合极低剂量（左旋布比卡因3.75毫克；舒芬太尼2.5微克）或低剂量（左旋布比卡因7.5毫克；舒芬太尼2.5微克）脊髓镇痛组。
主要终点为术后30分钟、1小时、2小时、4小时和24小时的围手术期阿片类药物消耗量和疼痛评分（11点数字评分量表）。次要终点为患者对麻醉护理的满意度和参与研究情况、七氟烷消耗量及不良反应。
对照组术中舒芬太尼（中位数[95%CI]）消耗量为16.1（10.5 - 22.6）微克/小时，极低剂量脊髓镇痛组为4.7（3.2 - 9.2）微克/小时，低剂量脊髓镇痛组为2.9（0.0 - 4.0）微克/小时（两组比较，p < 0.001）。术后24小时对照组哌替啶中位数（95%CI）消耗量为7.5（3 - 8）毫克，极低剂量脊髓镇痛组为5（0 - 7.5）毫克（p = 0.182），低剂量脊髓镇痛组为2（0 - 2.5）毫克（p = 0.001）。仅低剂量脊髓镇痛组术后疼痛评分始终<3分。所有组患者对麻醉护理的满意度和参与研究的积极性都很高。
低剂量脊髓镇痛联合全身麻醉可降低腹腔镜妇科手术后即刻围手术期阿片类药物的消耗量。
