Koo Jung Min, Chung Youn-Jee, Lee Mihyeon, Moon Young Eun
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
J Clin Med. 2023 Jan 2;12(1):350. doi: 10.3390/jcm12010350.
Remifentanil is widely used for intraoperative analgesia, but often causes remifentanil-induced hyperalgesia (RIH) and related side effects. Dexmedetomidine, a non-opioid analgesic, has been used as an alternative to remifentanil to prevent RIH. We aimed to investigate the effect of dexmedetomidine on postoperative recovery after gynecological laparoscopy. Ninety-six adult patients undergoing elective gynecological laparoscopy were randomly assigned to the dexmedetomidine or remifentanil groups. The primary outcome was the pain score at 30 min after surgery. The secondary outcomes were intraoperative adverse events (hypotension and bradycardia) and postoperative opioid-related side effects (nausea, vomiting, requirement for rescue analgesics, and shivering). We also performed an ancillary cytokine study to evaluate oxidative stress, one of the causes of RIH. Compared with the remifentanil group, the dexmedetomidine group had lower pain scores at 30 min after surgery (4.0 ± 1.9 vs. 6.1 ± 2.0, mean ± SD, p < 0.001) and lower incidence of intraoperative hypotension and postoperative nausea, vomiting, and shivering. Furthermore, the proportion of patients requiring rescue analgesics was significantly lower in the dexmedetomidine than in the remifentanil group (25% vs. 66.7%, p < 0.001). Cytokine levels did not differ between the groups. Dexmedetomidine showed a better analgesic effect with minimal opioid-related side effects and is considered superior to remifentanil for intraoperative analgesia.
瑞芬太尼广泛用于术中镇痛，但常引起瑞芬太尼诱发的痛觉过敏（RIH）及相关副作用。右美托咪定，一种非阿片类镇痛药，已被用作瑞芬太尼的替代品以预防RIH。我们旨在研究右美托咪定对妇科腹腔镜术后恢复的影响。96例择期行妇科腹腔镜手术的成年患者被随机分为右美托咪定组或瑞芬太尼组。主要结局是术后30分钟时的疼痛评分。次要结局是术中不良事件（低血压和心动过缓）以及术后阿片类药物相关副作用（恶心、呕吐、需要使用解救镇痛药和寒战）。我们还进行了一项辅助细胞因子研究以评估氧化应激，这是RIH的原因之一。与瑞芬太尼组相比，右美托咪定组术后30分钟时的疼痛评分更低（4.0±1.9 vs. 6.1±2.0，均值±标准差，p<0.001），术中低血压及术后恶心、呕吐和寒战的发生率更低。此外，右美托咪定组需要使用解救镇痛药的患者比例显著低于瑞芬太尼组（25% vs. 66.7%，p<0.001）。两组间细胞因子水平无差异。右美托咪定显示出更好的镇痛效果，且阿片类药物相关副作用最小，被认为在术中镇痛方面优于瑞芬太尼。
