Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands
Department of Anesthesiology, Máxima Medical Centre, Eindhoven, Noord-Brabant, The Netherlands.
Reg Anesth Pain Med. 2021 Nov;46(11):960-964. doi: 10.1136/rapm-2021-102884. Epub 2021 Aug 26.
A new potential target for multimodal pain management is the group-II metabotropic glutamate receptor subtypes, which can be activated by N-acetylcysteine. We investigated whether pre-emptive administration of N-acetylcysteine leads to a reduction in postoperative pain after laparoscopic inguinal hernia repair.
Sixty American Society of Anesthesiologists I-II patients scheduled for elective inguinal hernia repair were randomized to receive either N-acetylcysteine (150 mg/kg) or placebo intravenously 1 hour before surgery. The primary outcome was the visual analogue score during movement in the morning (approximately 24 hours) after surgery. Among secondary outcomes were postoperative opioid consumption and safety of intravenous N-acetylcysteine.
In total, 23 patients were analyzed per group. Pain scores were similar at all timepoints with a 24 hours median score of 34 (IQR of 19.0 to 42.5) in the N-acetylcysteine group and a median score of 26 (16.0 to 50.0) in the placebo group. The percentage of patients using opioids after surgery was 22% versus 39% day 1 (p=0.63); 9% versus 26% day 2 (p=0.14); 9% versus 17% day 3 (p=0.35) in the N-acetylcysteine group compared with placebo group. Side effects resembling anaphylactoid reactions in response to the administration of N-acetylcysteine were present in more than half of the patients.
Without finding important differences between N-acetylcysteine and placebo group in pain scores postoperatively, but with a high percentage of bothersome side effects for the N-acetylcysteine group, we would not recommend the use of pre-emptive intravenous N-acetylcysteine to reduce postoperative pain in laparoscopic inguinal hernia repair patients based on this study.
NCT03354572.
群 II 代谢型谷氨酸受体亚型是多模式疼痛管理的新潜在靶点，其可被 N-乙酰半胱氨酸激活。我们研究了腹腔镜腹股沟疝修补术前预防性给予 N-乙酰半胱氨酸是否会减少术后疼痛。
60 例择期行腹腔镜腹股沟疝修补术的美国麻醉医师学会（ASA）I-II 级患者随机分为静脉注射 N-乙酰半胱氨酸（150mg/kg）或安慰剂组，术前 1 小时给药。主要结局是术后第 24 小时晨动时的视觉模拟评分。次要结局包括术后阿片类药物的使用和静脉注射 N-乙酰半胱氨酸的安全性。
每组 23 例患者纳入分析。所有时间点的疼痛评分相似，N-乙酰半胱氨酸组 24 小时的中位数评分（IQR：19.0 至 42.5）为 34 分，安慰剂组为 26 分（16.0 至 50.0）。术后使用阿片类药物的患者比例为：第 1 天 22% vs. 39%（p=0.63）；第 2 天 9% vs. 26%（p=0.14）；第 3 天 9% vs. 17%（p=0.35），N-乙酰半胱氨酸组分别低于安慰剂组。静脉注射 N-乙酰半胱氨酸后，半数以上患者出现类似过敏反应的副作用。
本研究未发现 N-乙酰半胱氨酸组与安慰剂组术后疼痛评分有显著差异，但 N-乙酰半胱氨酸组副作用发生率较高，因此我们不建议在腹腔镜腹股沟疝修补术中预防性使用静脉注射 N-乙酰半胱氨酸来减轻术后疼痛。
NCT03354572。
