Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
Department of Anesthesiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People's Republic of China.
BMC Anesthesiol. 2023 Jan 27;23(1):34. doi: 10.1186/s12871-023-01994-5.
Enhanced recovery after surgery (ERAS) is now widely used in various surgical fields including gynecological laparoscopic surgery, but the advantages of opioid-free anesthesia (OFA) in gynecological laparoscopic surgery under ERAS protocol are inexact.
This study aims to assess the effectiveness and feasibility of OFA technique versus traditional opioid-based anesthesia (OA) technique in gynecological laparoscopic surgery under ERAS.
Adult female patients aged 18 ~ 65 years old undergoing gynecological laparoscopic surgery were randomly divided into OFA group (Group OFA, n = 39) with esketamine and dexmedetomidine or OA group (Group OA, n = 38) with sufentanil and remifentanil. All patients adopted ERAS protocol. The primary outcome was the area under the curve (AUC) of Visual Analogue Scale (VAS) scores (AUC) postoperatively. Secondary outcomes included intraoperative hemodynamic variables, awakening and orientation recovery times, number of postoperative rescue analgesia required, incidence of postoperative nausea and vomiting (PONV) and Pittsburgh Sleep Quality Index (PSQI) perioperatively.
AUC was (Group OFA, 16.72 ± 2.50) vs (Group OA, 15.99 ± 2.72) (p = 0.223). No difference was found in the number of rescue analgesia required (p = 0.352). There were no between-group differences in mean arterial pressure (MAP) and heart rate (HR) (p = 0.211 and 0.659, respectively) except MAP at time of surgical incision immediately [(Group OFA, 84.38 ± 11.08) vs. (Group OA, 79.00 ± 8.92), p = 0.022]. Times of awakening and orientation recovery in group OFA (14.54 ± 4.22 and 20.69 ± 4.92, respectively) were both longer than which in group OA (12.63 ± 3.59 and 18.45 ± 4.08, respectively) (p = 0.036 and 0.033, respectively). The incidence of PONV in group OFA (10.1%) was lower than that in group OA (28.9%) significantly (p = 0.027). The postoperative PSQI was lower than the preoperative one in group OFA (p = 0.013).
In gynecological laparoscopic surgery under ERAS protocol, OFA technique is non-inferior to OA technique in analgesic effect and intraoperative anesthesia stability. Although awakening and orientation recovery times were prolonged compared to OA, OFA had lower incidence of PONV and improved postoperative sleep quality.
ChiCTR2100052761, 05/11/2021.
加速康复外科（ERAS）现在广泛应用于包括妇科腹腔镜手术在内的各个外科领域，但在 ERAS 方案下，无阿片类麻醉（OFA）在妇科腹腔镜手术中的优势并不明确。
本研究旨在评估 OFA 技术与传统阿片类药物基础麻醉（OA）技术在 ERAS 下妇科腹腔镜手术中的有效性和可行性。
选择年龄在 18~65 岁之间、接受妇科腹腔镜手术的成年女性患者，随机分为 OFA 组（OFA 组，n=39），给予 Esketamine 和 Dexmedetomidine；或 OA 组（OA 组，n=38），给予 Sufentanil 和 Remifentanil。所有患者均采用 ERAS 方案。主要结局是术后视觉模拟量表（VAS）评分的曲线下面积（AUC）。次要结局包括术中血流动力学变量、苏醒和定向恢复时间、术后需要的补救性镇痛次数、术后恶心和呕吐（PONV）发生率和匹兹堡睡眠质量指数（PSQI）。
OFA 组 AUC 为（16.72±2.50），OA 组 AUC 为（15.99±2.72）（p=0.223）。需要补救性镇痛的次数无差异（p=0.352）。两组平均动脉压（MAP）和心率（HR）无差异（p=0.211 和 0.659），除手术切口即刻的 MAP 外[OFA 组（84.38±11.08）vs. OA 组（79.00±8.92），p=0.022]。OFA 组苏醒和定向恢复时间（14.54±4.22 和 20.69±4.92）均长于 OA 组（12.63±3.59 和 18.45±4.08）（p=0.036 和 0.033）。OFA 组 PONV 发生率（10.1%）低于 OA 组（28.9%）（p=0.027）。OFA 组术后 PSQI 低于术前（p=0.013）。
在 ERAS 方案下的妇科腹腔镜手术中，OFA 技术在镇痛效果和术中麻醉稳定性方面与 OA 技术无差异。虽然与 OA 相比，OFA 组患者的苏醒和定向恢复时间延长，但 PONV 发生率较低，术后睡眠质量改善。
ChiCTR2100052761，2021 年 5 月 11 日。
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