Qian Yiling, Huang Zhifei, Wang Guilong, Han Jinghong, Zhou Difei, Ding Hailei, Zhang Xin
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
Front Pharmacol. 2022 Nov 18;13:1050847. doi: 10.3389/fphar.2022.1050847. eCollection 2022.
Sufentanil, a potent opioid, serves as the first option for perioperative analgesia owing to its analgesic effect, long duration and stable hemodynamics, whereas its side effects frequently blunt its application. The intravenous (IV) injection of sufentanil during anesthesia induction has high incidence of choking or bucking reaction, which is defined as sufentanil-induced cough (SIC). Moreover, postoperative nausea and vomiting (PONV) is a common and stressful complication, which is also related to the usage of opioid. High incidence of PONV is reported in the patients with SIC. Hence, we sought to determine whether naloxone, an opioid antagonist, at low dose would decrease the incidences of SIC and PONV. 216 female patients undergoing gynecological laparoscopic operation (<2 h) under general anesthesia were recruited in this study, and randomly assigned into two groups: Group N (patients receiving naloxone and Group C (patients receiving vehicle). Sufentanil (0.5 μg/kg within 5 s) was given in anesthesia induction, and low-dose naloxone (1.25 μg/kg) or identical vehicle was initially injected 5 min prior to induction, with the incidence and severity of SIC estimated. Subsequently, naloxone or vehicle was continuously infused at the rate of 0.5 μg/kg/h in the initiation of operation until the end of the operation, and the transverse abdominal fascia block (TAP) was performed for postoperative analgesia. The PONV profiles such as incidence and the severity, grading, and the frequencies of antiemetic usage within 24 h were evaluated, with VAS scores and remedial measures for analgesia during the first 24 h postoperatively were recorded. Our results revealed that one bolus of low-dose naloxone prior to the induction significantly mitigated the incidence of SIC, and intraoperative continuous infusion of low-dose naloxone reduced the incidence and the severity of PONV, so that the postoperative VAS scores and further remedial analgesia were not altered. These results not only provide clinical solutions for prophylaxis of SIC and PONV, but also suggests that opioids may act as a key role in both SIC and PONV, whereas opioid antagonist may hit two tasks with one stone. Moreover, further investigations are required to address the underlying mechanism of SIC and PONV. : [www.chictr.org.cn], identifier [ChiCTR2200064865].
舒芬太尼是一种强效阿片类药物,因其镇痛效果、作用时间长和血流动力学稳定,成为围手术期镇痛的首选药物,但其副作用常常限制了它的应用。麻醉诱导期间静脉注射舒芬太尼时,呛咳或躯体扭动反应的发生率很高,这被定义为舒芬太尼诱发的咳嗽(SIC)。此外,术后恶心呕吐(PONV)是一种常见且令人困扰的并发症,这也与阿片类药物的使用有关。据报道,发生SIC的患者PONV发生率很高。因此,我们试图确定低剂量的阿片类拮抗剂纳洛酮是否会降低SIC和PONV的发生率。本研究招募了216例接受全身麻醉下妇科腹腔镜手术(<2小时)的女性患者,并随机分为两组:N组(接受纳洛酮的患者)和C组(接受赋形剂的患者)。在麻醉诱导时给予舒芬太尼(5秒内0.5μg/kg),并在诱导前5分钟初始注射低剂量纳洛酮(1.25μg/kg)或相同的赋形剂,评估SIC的发生率和严重程度。随后,在手术开始时以0.5μg/kg/h的速率持续输注纳洛酮或赋形剂直至手术结束,并进行腹横筋膜阻滞(TAP)用于术后镇痛。评估PONV的情况,如发生率、严重程度、分级以及术后24小时内使用止吐药的频率,并记录术后24小时内的视觉模拟评分(VAS)和镇痛补救措施。我们的结果显示,诱导前一剂低剂量纳洛酮显著降低了SIC的发生率,术中持续输注低剂量纳洛酮降低了PONV的发生率和严重程度,且术后VAS评分和进一步的补救镇痛未受影响。这些结果不仅为预防SIC和PONV提供了临床解决方案,还表明阿片类药物可能在SIC和PONV中都起关键作用,而阿片类拮抗剂可能一举两得。此外,需要进一步研究以阐明SIC和PONV的潜在机制。:[www.chictr.org.cn],标识符[ChiCTR2200064865]