Xie Kai, Wang Yu-Long, Teng Wen-Bin, He Rui, Li Yu-Hong, Huang Su-Qin
Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China.
Department of Anesthesiology, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China.
Front Med (Lausanne). 2022 Jan 21;8:808850. doi: 10.3389/fmed.2021.808850. eCollection 2021.
Oxycodone can be used both intravenously and epidurally in elderly patients because of its strong analgesic effect and more slight respiratory inhibition compared with other opioids at the same effect. In this study, we determined the median effective concentration (EC) of epidural ropivacaine required for great saphenous vein surgery in elderly patients in order to describe its pharmacodynamic interaction with oxycodone.
One hundred forty-one elderly patients scheduled for high ligation and stripping of the great saphenous vein surgery were allocated into three groups in a randomized, double-blinded manner as follows: Q2.5 group (2.5 mg oxycodone), Q5.0 group (5.0 mg oxycodone), and C group (normal saline). Anesthesia, was achieved with epidural ropivacaine and oxycodone. The EC of ropivacaine for surgery with different doses of oxycodone was adjusted by using an up-and-down sequential methods with an adjacent concentration gradient at a factor of 0.9 to inhibit analgesia. Anesthesia associated adverse events and recovery, characteristics were also recorded.
The EC of ropivacaine for the great saphenous vein surgery in elderly patients was 0.399% (95% CI, 0.371-0.430%) in the Q2.5 group, 0.396% (95% CI, 0.355-0.441%) in the Q5.0 group, and 0.487% (95% CI, 0.510-0.465%) in the C group, respectively ( < 0.05). Specially, the EC of ropivacaine in the Q2.5 and Q5.0 groups was lower than that in the C group ( < 0.01), But the difference between the Q2.5 group and the Q5.0 group was not significant ( > 0.05). There was no significant difference in the Bromage score from the motor block examination, heart rate (HR) or mean arterial pressure (MAP) at each observation time point after epidural administration among the three groups ( > 0.05). No serious adverse reactions occurred in any of the three groups.
Oxycodone combined with ropivacaine epidural anesthesia can reduce the EC of ropivacaine required for elderly patients undergoing the great saphenous vein surgery. There was no significant difference in anesthesia associated adverse events among the three groups. The recommended dose of oxycodone is 2.5 mg.
由于羟考酮具有较强的镇痛作用，且与其他阿片类药物在同等效应下呼吸抑制作用更轻微，因此可用于老年患者的静脉和硬膜外给药。在本研究中，我们测定了老年患者大隐静脉手术所需硬膜外罗哌卡因的半数有效浓度（EC），以描述其与羟考酮的药效学相互作用。
141例计划行大隐静脉高位结扎剥脱术的老年患者，采用随机、双盲方式分为三组：Q2.5组（2.5mg羟考酮）、Q5.0组（5.0mg羟考酮）和C组（生理盐水）。采用硬膜外罗哌卡因和羟考酮进行麻醉。采用序贯法，相邻浓度梯度为0.9，调整不同剂量羟考酮下罗哌卡因用于手术的EC，以抑制镇痛。记录麻醉相关不良事件和恢复情况、特征。
Q2.5组老年患者大隐静脉手术罗哌卡因的EC为0.399%（95%CI，0.371 - 0.430%），Q5.0组为0.396%（95%CI，0.355 - 0.441%），C组为0.487%（95%CI，0.510 - 0.465%），差异有统计学意义（P<0.05）。特别地，Q2.5组和Q5.0组罗哌卡因的EC低于C组（P<0.01），但Q2.5组和Q5.0组之间差异无统计学意义（P>0.05）。三组硬膜外给药后各观察时间点运动阻滞检查的布罗玛杰评分、心率（HR）或平均动脉压（MAP）差异无统计学意义（P>0.05）。三组均未发生严重不良反应。
羟考酮联合罗哌卡因硬膜外麻醉可降低老年患者大隐静脉手术所需罗哌卡因的EC。三组麻醉相关不良事件差异无统计学意义。羟考酮的推荐剂量为2.5mg。
