Department of Anaesthesiology, Santa Genoveva Hospital Complex, Uberlândia, Minas Gerais, Brazil.
Botucatu School of Medicine, UNESP, São Paulo, Brazil.
Anaesthesia. 2021 Feb;76(2):199-208. doi: 10.1111/anae.15173. Epub 2020 Jul 27.
The effect of intra-operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m who underwent bariatric surgery. Patients were allocated at random to receive either intra-operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery-40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post-anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery-40 questionnaire score of 194 (190-197 [165-200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174-185.5 [121-200]) in the morphine group. In the post-anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra-operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra-operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid-related adverse events.
本研究旨在比较术中静脉注射美沙酮与吗啡对腹腔镜胃旁路术后患者术后恢复质量的影响。我们纳入了 137 名 BMI>35kg/m²的成人肥胖患者，这些患者均接受减重手术。患者随机分为美沙酮组（n=69）和吗啡组（n=68）。所有患者均接受相同的术后护理和镇痛。术后恢复质量的主要结局通过术后 24 小时的恢复质量问卷（Quality of Recovery-40，QoR-40）总评分进行评估。次要结局在手术当天的麻醉后恢复室（T1）、手术后早晨（T2）和手术后次日晚上（T3）进行评估。美沙酮组的 QoR-40 问卷总评分中位数（IQR[范围]）为 194（190-197[165-200]），高于吗啡组的 181（174-185.5[121-200]）（p<0.0001）。在麻醉后恢复室，美沙酮组的疼痛负担、恶心呕吐发生率、吗啡解救剂量和出院时间显著低于吗啡组。在病房，美沙酮组在 T1（5.8% vs. 54.4%，p<0.0001）和 T2（0% vs. 20.1%，p<0.0001）时吗啡解救需求的发生率以及 T1 时恶心（21.7% vs. 41.2%，p=0.014）的发生率均显著低于吗啡组。综上，与术中静脉注射吗啡相比，术中静脉注射美沙酮可改善腹腔镜胃旁路术患者的术后恢复质量。美沙酮还降低了术后疼痛、术后阿片类药物消耗和阿片类药物相关不良反应的发生率。
