布比卡因/曲马多或布比卡因/右美托咪定早期与晚期腹腔内给药用于腹部腹腔镜癌症手术围手术期镇痛的比较研究：一项前瞻性随机研究

Comparative Study Between Early versus Late Intraperitoneal Administration of Either Bupivacaine/Tramadol or Bupivacaine/Dexmedetomidine for Perioperative Analgesia in Abdominal Laparoscopic Cancer Surgeries: A Prospective Randomized Study.

作者信息

Shaker Ehab H, Soliman Mahmoud S, Hanafy Ayman, Elsabeeny Walaa Y

机构信息

Department of Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.

Department of Anesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.

出版信息

J Pain Res. 2022 Oct 18;15:3233-3243. doi: 10.2147/JPR.S376681. eCollection 2022.

DOI:10.2147/JPR.S376681

PMID:36281310

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9587727/

Abstract

OBJECTIVE

Several modalities for analgesia after laparoscopic procedures have been used. This study aimed to investigate the efficacy of early versus late bupivacaine/tramadol combination and bupivacaine/dexmedetomidine combination in analgesia for laparoscopic cancer surgeries.

METHODS

A total of 100 patients of both genders scheduled for elective laparoscopic cancer surgeries were included. Patients were randomly assigned to one of four groups each comprises 25 patients. Group 1: early bupivacaine/tramadol, Group 2: late bupivacaine/tramadol, Group 3: early bupivacaine/dexmedetomidine, and Group 4: late bupivacaine/dexmedetomidine. Early groups received the intraperitoneal instillation before start of surgery and late groups received the instillation after completion of surgery. Perioperative heart rate (HR) and mean arterial blood pressure (MAP) were recorded. The degree of postoperative pain was measured at rest and with cough using Visual analogue scale (VAS) score at 2, 4, 6, 12, 18 and 24 h after surgery. In addition, the total intraoperative fentanyl and postoperative morphine doses were calculated.

RESULTS

Both late bupivacaine/tramadol, bupivacaine/dexmedetomidine groups had longer time to receive first analgesic requirement (13.4±3.9, 11.3±3.9 h) respectively as compared to early bupivacaine/tramadol, bupivacaine/dexmedetomidine groups (9.8± 3.6, 8.4± 2.8 h), respectively. Between each early and late group, intraoperative fentanyl consumption was higher for the late groups (75± 22.8, 73± 21.55µg) versus (32.7± 10.9, 37.5± 13.3 µg), respectively. As regards to rescue analgesic requirements, both early bupivacaine/tramadol and bupivacaine/dexmedetomidine groups consumed more analgesics (5.2± 2.0 and 6.1± 1.8 mg) as compared to the late groups (3.2± 0.8 and 4.3± 1.5 mg), respectively. The four groups were comparable for their perioperative HR and MAP values.

CONCLUSION

Intraperitoneal instillation of bupivacaine/tramadol and bupivacaine/dexmedetomidine could be considered an effective route for analgesic administration during laparoscopic cancer surgeries. Early instillation reduced the intraoperative opioid consumption and late instillation resulted in reduced postoperative opioid consumption.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT04813016.

摘要

目的

腹腔镜手术后已采用多种镇痛方式。本研究旨在探讨早期与晚期布比卡因/曲马多联合用药及布比卡因/右美托咪定联合用药在腹腔镜癌症手术镇痛中的疗效。

方法

纳入100例计划行择期腹腔镜癌症手术的患者，男女不限。患者随机分为四组，每组25例。第1组：早期布比卡因/曲马多；第2组：晚期布比卡因/曲马多；第3组：早期布比卡因/右美托咪定；第4组：晚期布比卡因/右美托咪定。早期组在手术开始前进行腹腔内滴注，晚期组在手术结束后进行滴注。记录围手术期心率（HR）和平均动脉血压（MAP）。术后2、4、6、12、18和24小时，使用视觉模拟评分法（VAS）在静息和咳嗽时测量术后疼痛程度。此外，计算术中芬太尼总量和术后吗啡用量。

结果

与早期布比卡因/曲马多组、布比卡因/右美托咪定组（分别为9.8±3.6、8.4±2.8小时）相比，晚期布比卡因/曲马多组、布比卡因/右美托咪定组分别有更长的时间达到首次镇痛需求（分别为13.4±3.9、11.3±3.9小时）。在每组早期和晚期组之间，晚期组术中芬太尼消耗量更高（分别为75±22.8、73±21.55μg），而早期组分别为（32.7±10.9、37.5±13.3μg）。关于补救镇痛需求，早期布比卡因/曲马多组和布比卡因/右美托咪定组消耗的镇痛药均多于晚期组（分别为5.2±2.0和6.1±1.8mg），晚期组分别为（3.2±0.8和4.3±1.5mg）。四组围手术期HR和MAP值具有可比性。