Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospital Pvt. Ltd, #313, Mettupalayam Road, Sai Baba Colony, Coimbatore, Tamilnadu, 641001, India.
Eur Spine J. 2021 Mar;30(3):698-705. doi: 10.1007/s00586-020-06539-9. Epub 2020 Jul 21.
To evaluate whether use of dexmedetomidine, a centrally acting α2 adrenergic agonist, reduces opioid consumption in PSF.
Adolescent idiopathic scoliosis patients who underwent PSF were randomized into morphine (M) and dexmedetomidine (D) group. M group received a 10 μg/kg/h IV infusion of morphine for 24 h post-surgery, while the D group received a 0.4 μg/kg/h IV infusion of dexmedetomidine. Trained nursing staffs recorded hourly vital parameters (blood pressure, pulse rate, respiratory rate, and oxygen saturation). Pain, postoperative nausea/vomiting (PONV), and sedation were rated using: the numerical rating scale (NRS), the PONV scale, and sedation status scale (SS). Preemptive analgesia with gabapentin and postoperative analgesia with ketorolac and paracetamol were used in both the groups. Any complications in the study groups were recorded.
No significant difference was noted between the groups (M vs D) with respect to NRS (3.1 ± 0.8 vs 2.7 ± 0.5) (p = 0.07) and breakthrough analgesia requirements (0.78 vs 0.45) (p = 0.17). A significant difference was noted between the groups with respect to the secondary outcome measures of time to ambulation (56.6 ± 12.7 h vs 45.2 ± 7.7 h), time to oral analgesics (84.3 ± 20 h vs 64.0 ± 15.4 h), and time to liquid intake (8.3 ± 1.3 h vs 7.2 ± 1.2 h). The M group had a higher PONV score (0.46 ± 0.3 vs 0.16 ± 0.1) (p < 0.001) and mean time to bowel opening (112.7 ± 28.4 h vs 90.1 ± 20.5 h) (p < 0.001). Additionally, the enema or suppository requirements for bowel opening were significantly more (0.59 ± 0.6 vs 0.26 ± 0.4) (p = 0.01) in the M group.
Dexmedetomidine provided analgesia comparable to morphine with lower PONV scores. It also reduced the opioid requirements in the PSF patients without additional complications and can therefore be incorporated in pain management protocols.
评估在 PSF 中使用具有中枢作用的 α2 肾上腺素能激动剂右美托咪定是否会减少阿片类药物的消耗。
接受 PSF 的青少年特发性脊柱侧凸患者被随机分为吗啡（M）和右美托咪定（D）组。M 组术后 24 小时内接受 10μg/kg/h 的静脉输注吗啡，而 D 组接受 0.4μg/kg/h 的静脉输注右美托咪定。经过培训的护理人员每小时记录生命体征（血压、脉搏率、呼吸频率和血氧饱和度）。使用数字评分量表（NRS）、术后恶心/呕吐（PONV）量表和镇静状态量表（SS）来评估疼痛、术后恶心/呕吐（PONV）和镇静。两组均使用加巴喷丁进行预防性镇痛和酮咯酸和对乙酰氨基酚进行术后镇痛。记录研究组的任何并发症。
M 组和 D 组在 NRS（3.1±0.8 与 2.7±0.5）（p=0.07）和突破性镇痛需求（0.78 与 0.45）（p=0.17）方面无显著差异。两组在次要观察指标方面存在显著差异，包括：行走时间（56.6±12.7 小时与 45.2±7.7 小时）、口服镇痛药时间（84.3±20 小时与 64.0±15.4 小时）和液体摄入时间（8.3±1.3 小时与 7.2±1.2 小时）。M 组的 PONV 评分更高（0.46±0.3 与 0.16±0.1）（p<0.001）和首次排便时间（112.7±28.4 小时与 90.1±20.5 小时）（p<0.001）更长。此外，M 组排便时需要灌肠或栓剂的次数明显更多（0.59±0.6 与 0.26±0.4）（p=0.01）。
右美托咪定提供的镇痛效果与吗啡相当，PONV 评分更低。它还降低了 PSF 患者对阿片类药物的需求，没有增加并发症，因此可以纳入疼痛管理方案。
