Jia Zhen, Chen Yi, Gao Tianyu, Yuan Yuan, Zheng Yuxin, Xie Yegong, Wang Guolin, Yu Yonghao, Zhang Linlin
Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Research Institute of Anesthesiology, Tianjin, China.
Front Pharmacol. 2023 Jan 25;14:1131812. doi: 10.3389/fphar.2023.1131812. eCollection 2023.
Intraoperative remifentanil infusion may paradoxically induce post-surgical hyperalgesia. Dexmedetomidine reportedly reduces opioid-induced hyperalgesia. Nalmefene selectively reverses several side-effects of opioids without impairing analgesia. Herein, this randomized, double-blind controlled trial investigated whether nalmefene, dexmedetomidine, and both drugs combined prevent remifentanil-induced hyperalgesia. One hundred and fifty patients undergoing elective laparoscopic gynecological surgery under desflurane anesthesia randomly received either intraoperative sufentanil 0.20 μg kg (Group S), or remifentanil 0.20 μg kg min (Group R), or remifentanil and pre-anesthesia nalmefene 0.20 μg kg (Group N), or remifentanil and pre-anesthesia dexmedetomidine 0.50 μg kg (Group D), or remifentanil and the combination of dexmedetomidine 0.25 μg kg and nalmefene 0.10 μg kg (Group DN). The threshold of postoperative mechanical hyperalgesia (primary outcome) was measured with von Frey filaments. We also recorded pain intensity, analgesic consumptions, hyperalgesic area, and side-effects for 24 h postoperatively. Compared with Group S, remifentanil reduced hyperalgesic threshold on the forearm [mean 89.4 (SD 13.7) vs. 62.2 (10.7) g, < 0.001] at postoperative 24 h. Pain threshold on the forearm at postoperative 24 h was significantly lower in Group R than in Groups N, D and DN [62.2 (10.7) vs. 71.1 (12.3), 72.4 (12.9) and 78.0 (13.8) g]. Compared with Group R, Postoperative pain intensity, analgesic consumption and hyperalgesic area were lower likewise in Groups D and DN. However, the incidence of intraoperative bradycardia was lower and post-anesthesia recovery time was shorter in Group DN than Group D. Preoperative therapy of dexmedetomidine and nalmefene combined attenuates postoperative hyperalgesia in patients undergoing laparoscopic gynecological surgery under desflurane-remifentanil anesthesia.
术中输注瑞芬太尼可能反常地诱发术后痛觉过敏。据报道，右美托咪定可减轻阿片类药物诱发的痛觉过敏。纳美芬可选择性地逆转阿片类药物的多种副作用而不影响镇痛效果。在此，这项随机、双盲对照试验研究了纳美芬、右美托咪定以及两者联合使用是否能预防瑞芬太尼诱发的痛觉过敏。150例在地氟醚麻醉下接受择期腹腔镜妇科手术的患者被随机分为术中静脉输注舒芬太尼0.20μg/kg组（S组）、瑞芬太尼0.20μg·kg⁻¹·min⁻¹组（R组）、瑞芬太尼联合麻醉前静脉注射纳美芬0.20μg/kg组（N组）、瑞芬太尼联合麻醉前静脉注射右美托咪定0.50μg/kg组（D组）、瑞芬太尼联合麻醉前静脉注射右美托咪定0.25μg/kg和纳美芬0.10μg/kg组（DN组）。采用von Frey细丝测量术后机械性痛觉过敏阈值（主要指标）。我们还记录了术后24小时的疼痛强度、镇痛药物消耗量、痛觉过敏区域和副作用。与S组相比，瑞芬太尼使术后24小时前臂的痛觉过敏阈值降低[平均值89.4（标准差13.7）对62.2（10.7）g，P<0.001]。R组术后24小时前臂的疼痛阈值显著低于N组、D组和DN组[62.2（10.7）对71.1（12.3）、72.4（12.9）和78.0（13.8）g]。与R组相比，D组和DN组术后疼痛强度、镇痛药物消耗量和痛觉过敏区域同样较低。然而，DN组术中心动过缓的发生率低于D组，且麻醉后恢复时间更短。在接受地氟醚-瑞芬太尼麻醉的腹腔镜妇科手术患者中，术前联合使用右美托咪定和纳美芬可减轻术后痛觉过敏。
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