Choi Hoon, Song Jae Yen, Oh Eun Jee, Chae Min Suk, Yu Sanghyuck, Moon Young Eun
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Pain Res. 2022 Aug 3;15:2197-2209. doi: 10.2147/JPR.S373412. eCollection 2022.
Opioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy.
Seventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels.
The patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: -11.0, 95% confidence interval: -20.0, -2.0; = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group ( = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group ( = 0.002).
OFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.
无阿片类药物麻醉（OFA）是一种新兴技术，可消除术中阿片类药物的使用，并与术后较低的阿片类药物消耗量及减少术后不良事件相关。本研究调查了OFA对接受妇科腹腔镜手术患者恢复质量的影响。
75例接受择期妇科腹腔镜手术的成年患者被随机分配至使用右美托咪定和利多卡因的OFA组或使用瑞芬太尼的基于瑞芬太尼的麻醉（RA）组。提供术后护理和评估结果的患者、外科医生及医务人员对分组情况不知情。由于两组给药方案不同，实施全身麻醉的麻醉医生无法不知情。主要结局是使用恢复质量-40（QoR-40）问卷测量的恢复质量。次要结局包括术后疼痛评分、术中和术后不良事件以及应激激素水平。
两组患者的基线特征具有可比性。术后第1天，OFA组的QoR-40评分显著高于RA组（RA组为155.9±21.2，OFA组为166.9±17.8；平均差值：-11.0，95%置信区间：-20.0，-2.0；P = 0.018）。术后30分钟时，OFA组的视觉模拟量表评分显著低于RA组（RA组为6.3±2.3，OFA组为4.1±2.1；P < 0.001）。麻醉后护理单元中恶心和寒战的发生率在OFA组也显著更低（分别为P = 0.014和0.025）。OFA组的肾上腺素水平显著更低（P = 0.002）。
OFA显著改善了接受妇科腹腔镜手术患者的恢复质量。
