Wang Xu-Ru, Jia Xiao-Yu, Jiang Yan-Yu, Li Zhen-Ping, Zhou Qing-He
Anesthesia Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
Front Surg. 2023 Jan 6;9:1035972. doi: 10.3389/fsurg.2022.1035972. eCollection 2022.
Opioid-based anesthesia is a traditional form of anesthesia that has a significant analgesic effect; however, it can cause nausea, vomiting, delirium, and other side effects. Opioid-free anesthesia with dexmedetomidine and lidocaine has attracted widespread attention. This study aimed to compare the effects of opioid-free and opioid-based anesthesia (OFA and OBA, respectively) on postoperative recovery in patients who had undergone video-assisted thoracic surgery.
Eighty patients undergoing video-assisted thoracic surgery were assigned to receive either opioid-free anesthesia (OFA group) or opioid-based anesthesia (OBA group) according to random grouping. The primary outcome of the study was the quality of recovery-40 scores (QoR-40) 24 h postoperatively. The secondary outcome measure was numerical rating scale (NRS) scores at different times 48 h postoperatively. In addition to these measurements, other related parameters were recorded.
Patients who received opioid-free anesthesia had higher QoR-40 scores (169.1 ± 5.1 vs 166.8 ± 4.4, = 0.034), and the differences were mainly reflected in their comfort and emotional state; however, the difference between the two groups was less than the minimal clinically important difference of 6.3. We also found that the NRS scores were lower in the OFA group than in the OBA group at 0.5 h (both 0.05) and 1 h (both 0.05) postoperatively and the cumulative 0-24 h postoperative dosage of sufentanil in the OBA group was higher than that in the OFA group (0.030). There were no significant differences in postoperative nausea and vomiting (PONV) (0.159). No surgical or block complications were observed between the groups.
Opioid-free analgesia potentially increased the postoperative recovery in patients who underwent video-assisted thoracic surgery.
The study protocol was registered in the Chinese Clinical Trial Register under the number ChiCTR2100045344 (http://www.chictr.org.cn/showproj.aspx?proj=125033) on April 13, 2021.
基于阿片类药物的麻醉是一种具有显著镇痛效果的传统麻醉方式；然而，它会引起恶心、呕吐、谵妄及其他副作用。使用右美托咪定和利多卡因的无阿片类药物麻醉已引起广泛关注。本研究旨在比较无阿片类药物麻醉和基于阿片类药物麻醉（分别为OFA和OBA）对接受电视辅助胸腔手术患者术后恢复的影响。
80例接受电视辅助胸腔手术的患者根据随机分组被分配接受无阿片类药物麻醉（OFA组）或基于阿片类药物麻醉（OBA组）。研究的主要结局是术后24小时的恢复质量-40评分（QoR-40）。次要结局指标是术后48小时不同时间的数字评分量表（NRS）评分。除这些测量外，还记录了其他相关参数。
接受无阿片类药物麻醉的患者QoR-40评分更高（169.1±5.1 vs 166.8±4.4，P = 0.034），差异主要体现在舒适度和情绪状态方面；然而，两组之间的差异小于临床最小重要差异6.3。我们还发现，术后0.5小时（均P < 0.05）和1小时（均P < 0.05）时，OFA组的NRS评分低于OBA组，且OBA组术后0 - 24小时舒芬太尼的累积用量高于OFA组（P = 0.030）。术后恶心呕吐（PONV）无显著差异（P = 0.159）。两组之间未观察到手术或阻滞并发症。
无阿片类药物镇痛可能提高接受电视辅助胸腔手术患者的术后恢复。
该研究方案于2021年4月13日在中国临床试验注册中心注册，注册号为ChiCTR2100045344（http://www.chictr.org.cn/showproj.aspx?proj=125033）。
