Toleska Marija, Dimitrovski Aleksandar, Dimitrovska Natasha Toleska
University Clinical Center "Mother Teresa" Skopje, University Clinic of TOARILUC, Department of Anesthesiology, Reanimation and Intensive Care - KARIL, Medical Faculty - Skopje, University ″Ss. Cyril and Methodius″ Skopje, Republic of Macedonia.
University Clinical Center "Mother Teresa" Skopje, University Clinic for Thoracic and Vascular Surgery, Medical Faculty -Skopje, University ″Ss. Cyril and Methodius″ Skopje, Republic of Macedonia.
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2022 Dec 4;43(3):101-108. doi: 10.2478/prilozi-2022-0042. Print 2022 Nov 1.
: Postoperative nausea and vomiting (PONV) is a usual complication in patients undergoing laparoscopic cholecystectomy. Minimized opioid use due to surgery has been shown to have a better effect on patient recovery after surgery. In this study we evaluate the effect of opioid free anesthesia for postoperative nausea and vomiting in laparoscopic cholecystectomy. : 80 patients aged 20-65 years old were included in this randomized, clinical and prospective trial. The patients belonged to the ASA classifications 1 and 2 and were scheduled for laparoscopic cholecystectomy. Patients were classified into two groups: group 1 (fentanyl group- FG), which included 40 patients who received opioid anesthesia, and group 2 (opioid free anesthesia group-OFAG) which included 40 patients who received opioid free anesthesia. In patients from group 1 (fentanyl group -FG) introduction to general anesthesia consisted of giving midazolam at 0.04 mg/kg, fentanyl at 0.002 mg/kg, 2 mg/kg of propofol and 0.6 mg/kg of rocuronium bromide. These patients received fractionated bolus doses of fentanyl during surgery. Prior to general anesthesia these patients did not receive dexamethasone. The patients from group 2 (opioid free anesthesia group - OFAG) received dexamethasone at 0.1 mg/kg and 1 g of paracetamol before introduction to anesthesia as a pre-emptive analgesia. Introduction to anesthesia consisted of giving midazolam at 0.04 mg/kg, lidocaine at 1 mg/kg, propofol at 2 mg/kg, ketamine at 0.5 mg/kg, and 0.6 mg/kg of rocuronium bromide. Immediately after intubation, continuous intravenous infusion with lidocaine at 2 mg/kg/h and magnesium sulfate at 1.5 g/h was given. In this group, fentanyl was not given either during the introduction of anesthesia or during the intraoperative period. Immediately after extraction of the gallbladder patients from group 2 (OFAG) received 2.5 g of metamizole intravenously. PONV were recorded in the postoperative period of 24 hours after surgery. : There was no significant difference with respect to age, weight, sex, duration of surgery, and anesthesia time. PONV at different time intervals were statistically not significant at all postoperative time points - 1 hr, 4 hr, 8 hr, 12 hr and 24 hr after surgery in fentanyl group compared to opioid free anesthesia group. Even not statistically significant, PONV have occurred more often in patients who received opioid anesthesia. : Postoperative nausea and vomiting occurs more often in patients who received opioids during laparoscopic cholecystectomy compared to patients who received opioid free anesthesia, but without statistical significance.
术后恶心呕吐（PONV）是接受腹腔镜胆囊切除术患者的常见并发症。手术中减少阿片类药物的使用已被证明对患者术后恢复有更好的效果。在本研究中，我们评估了无阿片类麻醉对腹腔镜胆囊切除术患者术后恶心呕吐的影响。80例年龄在20至65岁之间的患者被纳入这项随机、临床和前瞻性试验。这些患者属于ASA分级1级和2级，计划接受腹腔镜胆囊切除术。患者被分为两组：第1组（芬太尼组 - FG），包括40例接受阿片类麻醉的患者；第2组（无阿片类麻醉组 - OFAG），包括40例接受无阿片类麻醉的患者。第1组（芬太尼组 - FG）患者的全身麻醉诱导包括给予0.04mg/kg的咪达唑仑、0.002mg/kg的芬太尼、2mg/kg的丙泊酚和0.6mg/kg的罗库溴铵。这些患者在手术期间接受分次推注芬太尼。在全身麻醉前，这些患者未接受地塞米松。第2组（无阿片类麻醉组 - OFAG）患者在麻醉诱导前接受0.1mg/kg的地塞米松和1g对乙酰氨基酚作为超前镇痛。麻醉诱导包括给予0.04mg/kg的咪达唑仑、1mg/kg的利多卡因、2mg/kg的丙泊酚、0.5mg/kg的氯胺酮和0.6mg/kg的罗库溴铵。插管后立即给予2mg/kg/h的利多卡因和1.5g/h的硫酸镁持续静脉输注。在该组中，麻醉诱导期间和术中均未给予芬太尼。第2组（OFAG）患者胆囊切除后立即静脉给予2.5g安乃近。在术后24小时记录PONV情况。在年龄、体重、性别、手术时间和麻醉时间方面无显著差异。与无阿片类麻醉组相比，芬太尼组在术后所有时间点 - 术后1小时、4小时、8小时、12小时和24小时不同时间间隔的PONV在统计学上均无显著差异。即使无统计学意义，接受阿片类麻醉的患者发生PONV的频率更高。与接受无阿片类麻醉的患者相比，接受阿片类药物的患者在腹腔镜胆囊切除术后发生术后恶心呕吐的频率更高，但无统计学意义。
