Department of Anesthesiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Department of Anesthesiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China -
Minerva Anestesiol. 2022 Jun;88(6):439-447. doi: 10.23736/S0375-9393.22.15850-5. Epub 2022 Feb 14.
We performed this randomized controlled trial to evaluate the effect of opioid-free anesthesia (OFA) on postoperative analgesia after laparoscopic gynecologic surgery.
Seventy-eight patients undergoing laparoscopic gynecologic surgery were randomized to receive either OFA (group OF) or opioid-inclusive anesthesia (group C). Postoperative sufentanil consumption within the first 24 h, Visual Analogue Scale (VAS) for pain, postoperative equivalent milligrams of morphine (EMM), severity of postoperative nausea (PN) and vomiting (PV), prevalence of postoperative nausea and vomiting (PONV), use of antiemetics, time to first passage of flatus were compared by a two-tailed Student's t-test, Wilcoxon rank-sum tests or Fisher's exact tests. Repeated measures ANOVA was used to assess the effect of allocation of groups over time.
The median [IQR] sufentanil consumption within 24 h was lower in group OF (4[4.5]) than in group C (6[8], mean difference [MD]=-2, 95% confidence interval [CI] [-4 to 0], P=0.029). The VAS scores at rest and during coughing at 6 h (P=0.009 at rest; P=0.002 during coughing), VAS scores during coughing at 2 h (P=0.013) and 4 h (P=0.008), EMM (P=0.026), severities of PN (P=0.003) and PV (P=0.003), and the mean time to first passage of flatus (P=0.017) was significantly less in group OF than that in group C. The prevalence of PONV (26.3% [group OF], 68.4% [group C], OR=0.31, 95% CI [0.158 to 0.589], P<0.001), use of antiemetics (5.3% [group OF], 28.9% [group C], OR=0.136, 95% CI [0.028 to 0.667], P=0.012) was also significantly different between groups.
Compared to opioid-inclusive anesthesia during laparoscopic gynecologic surgery, OFA was associated with significant improvement in postoperative analgesia, reduced PONV incidence prevalence and severity, and faster first passage of flatus.
我们进行了这项随机对照试验，以评估腹腔镜妇科手术后无阿片类药物麻醉（OFA）对术后镇痛的影响。
78 例接受腹腔镜妇科手术的患者被随机分为接受 OFA（OFA 组）或包含阿片类药物的麻醉（C 组）。比较两组患者术后 24 小时内舒芬太尼的消耗量、疼痛视觉模拟量表（VAS）评分、术后等效吗啡毫克数（EMM）、术后恶心（PN）和呕吐（PV）的严重程度、术后恶心和呕吐（PONV）的发生率、止吐药的使用情况、首次排气时间。采用双侧 Student's t 检验、Wilcoxon 秩和检验或 Fisher 确切概率法进行比较。采用重复测量方差分析评估分组对时间的影响。
OFA 组（4[4.5]）24 小时内舒芬太尼消耗量中位数[IQR]低于 C 组（6[8]，平均差值[MD]=-2，95%置信区间[CI] [-4 至 0]，P=0.029）。6 小时时静息状态和咳嗽时的 VAS 评分（静息时 P=0.009；咳嗽时 P=0.002）、2 小时和 4 小时时咳嗽时的 VAS 评分（P=0.013 和 P=0.008）、EMM（P=0.026）、PN 严重程度（P=0.003）和 PV 严重程度（P=0.003），以及首次排气时间（P=0.017）OFA 组明显低于 C 组。PONV 发生率（OFA 组 26.3%，C 组 68.4%，OR=0.31，95%CI [0.158 至 0.589]，P<0.001）和止吐药使用率（OFA 组 5.3%，C 组 28.9%，OR=0.136，95%CI [0.028 至 0.667]，P=0.012）也有显著差异。
与腹腔镜妇科手术中的包含阿片类药物的麻醉相比，OFA 可显著改善术后镇痛效果，降低 PONV 的发生率和严重程度，加快首次排气时间。
