雷莫司琼和昂丹司琼预防关节镜肩袖修复术后恶心和呕吐的效果：一项随机对照试验。
The effectiveness of ramosetron and ondansetron for preventing postoperative nausea and vomiting after arthroscopic rotator cuff repair: a randomized controlled trial.
机构信息
Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
出版信息
J Orthop Surg Res. 2020 Nov 11;15(1):523. doi: 10.1186/s13018-020-02060-3.
BACKGROUND
Arthroscopic rotator cuff repair is a painful procedure, and treatment of emetic events associated with drugs used in the current multimodal pain management remains challenging. This study aimed to evaluate the effectiveness of ramosetron or ondansetron to relieve postoperative nausea and vomiting (PONV) and pain after arthroscopic rotator cuff repair.
METHODS
In total, 122 consecutive patients undergoing arthroscopic rotator cuff repair were randomly allocated into three groups: ramosetron group (n = 39), ondansetron group (n = 43), and control group (n = 40). Then, 0.3 mg of ramosetron or 8 mg of ondansetron was administered intravenously at the end of surgery according to group. All patients received general anesthesia and multimodal pain management protocol including preemptive analgesic medication, fentanyl-based intravenous patient-controlled analgesia, and postoperative analgesic medication. Incidence of emetic events, rescue antiemetic requirements (10 mg of metoclopramide, IV), complete response, pain level, and side effects were recorded in three periods: 0-6, 6-24, and 24-48 h postoperatively. The severity of nausea and pain was evaluated using a visual analog scale.
RESULTS
The ramosetron group tended to have a lower incidence and severity of nausea during the 6- to 24-h postoperative period and fewer rescue antiemetic drug requirements during the 0- to 48-h period than the control group, showing statistical significance. Additionally, the frequency of complete response of the ramosetron and ondansetron groups was significantly higher than that of the control group. No difference was found among the groups in the pain level except during the 0- to 6-h period. The two groups have a higher complete response during the 6- to 24-h period than the control group.
CONCLUSIONS
Ramosetron use led to a lower incidence, mild severity of nausea, and reduced use of rescue antiemetic drug after arthroscopic rotator cuff repair during the 6- to 24-h postoperative period than the control.
LEVEL OF EVIDENCE
Level I, randomized controlled trials, treatment study.
背景
关节镜下肩袖修复术是一种疼痛的手术，治疗当前多模式疼痛管理中使用的药物引起的呕吐事件仍然具有挑战性。本研究旨在评估雷莫司琼或昂丹司琼缓解关节镜下肩袖修复术后恶心和呕吐（PONV）和疼痛的效果。
方法
共纳入 122 例连续接受关节镜下肩袖修复术的患者，随机分为三组：雷莫司琼组（n=39）、昂丹司琼组（n=43）和对照组（n=40）。然后，根据组，在手术结束时静脉注射 0.3mg 雷莫司琼或 8mg 昂丹司琼。所有患者均接受全身麻醉和多模式疼痛管理方案，包括预防性镇痛药物、芬太尼静脉患者自控镇痛和术后镇痛药物。记录三组患者在三个时间段的呕吐事件发生率、需要解救性止吐药（10mg 甲氧氯普胺，静脉注射）的情况、完全缓解、疼痛水平和不良反应：术后 0-6h、6-24h 和 24-48h。采用视觉模拟评分法评估恶心和疼痛的严重程度。
结果
雷莫司琼组在术后 6-24h 期间恶心的发生率和严重程度较低，且在 0-48h 期间需要解救性止吐药物的次数较少，与对照组相比具有统计学意义。此外，雷莫司琼组和昂丹司琼组的完全缓解率明显高于对照组。三组患者的疼痛水平无差异，除了在 0-6h 期间。在 6-24h 期间，两组的完全缓解率均高于对照组。
结论
与对照组相比，关节镜下肩袖修复术后 6-24h 期间，雷莫司琼的使用可降低恶心的发生率、严重程度，减少解救性止吐药物的使用。
证据等级
I 级，随机对照试验，治疗研究。
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