Thappa Priya, Singh Nidhi, Luthra Ankur, Deshpande Pruthviraj, Chauhan Rajeev, Meena Shyam C, Kumar Vishal, Singla Navneet
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Asian Spine J. 2023 Oct;17(5):894-903. doi: 10.31616/asj.2022.0439. Epub 2023 Aug 14.
Prospective randomized double-blind study.
To assess the analgesic effects of the combination of a low-dose ketamine and dexmedetomidine (ketodex) infusion and compare it with that of fentanyl for postoperative analgesia after spine surgeries.
Adequate pain management following spine surgeries is crucial. Approximately 57% of patients experience inadequate pain control in the first 24 hours following elective spine surgery, which is attributable to the extensive soft tissue and muscle damage.
The study included 60 patients graded American Society of Anesthesiologists I and II and scheduled for thoracolumbar spine surgery involving >3 vertebral levels. The patients were divided into two groups: group KD (ketodex) and group F (fentanyl). The primary objective was to compare the postoperative analgesic requirements among the groups. The secondary objectives included a comparison of the intraoperative anesthetic requirements, postoperative pain scores, hemodynamic parameters, side effects of the study drugs, and the duration of post-anesthesia care unit stay of both the groups.
Ketodex use prolonged the mean time to first rescue analgesia (22.00±2.30 hours vs. 11.69±3.02 hours, p <0.001) and reduced the requirement of rescue analgesics in the first 24 hours postoperatively compared to fentanyl use (70.00±8.16 μg vs. 113.31±36.65 μg, p =0.03). The intraoperative requirement of desflurane was comparable between the groups (p >0.05). The postoperative pain scores were significantly lower in the group KD than in group F at most timepoints (p <0.05). Patients in group KD had a shorter post-anesthesia care unit stay than group F did (p <0.001).
Low-dose ketodex could be a safe substitute for fentanyl infusion when employed as an anesthetic adjuvant for patients undergoing thoracolumbar spine surgeries involving >3 vertebral levels to achieve prolonged analgesia without any opioidrelated side effects.
前瞻性随机双盲研究。
评估低剂量氯胺酮与右美托咪定联合输注（氯胺酮 - 右美托咪定）的镇痛效果，并将其与芬太尼用于脊柱手术后的术后镇痛效果进行比较。
脊柱手术后充分的疼痛管理至关重要。在择期脊柱手术后的头24小时内，约57%的患者疼痛控制不佳，这归因于广泛的软组织和肌肉损伤。
该研究纳入了60例美国麻醉医师协会I级和II级、计划进行涉及超过3个椎体节段的胸腰椎脊柱手术的患者。患者被分为两组：KD组（氯胺酮 - 右美托咪定）和F组（芬太尼）。主要目的是比较两组之间的术后镇痛需求。次要目的包括比较术中麻醉需求、术后疼痛评分、血流动力学参数、研究药物的副作用以及两组在麻醉后监护病房的停留时间。
与使用芬太尼相比，使用氯胺酮 - 右美托咪定延长了首次补救镇痛的平均时间（22.00±2.30小时对11.69±3.02小时，p<0.001），并降低了术后头24小时内补救镇痛药的需求量（70.00±8.16μg对113.31±36.65μg，p = 0.03）。两组之间地氟醚的术中需求量相当（p>0.05）。在大多数时间点，KD组的术后疼痛评分显著低于F组（p<0.05）。KD组患者在麻醉后监护病房的停留时间比F组短（p<0.001）。
当低剂量氯胺酮 - 右美托咪定作为麻醉辅助剂用于接受涉及超过3个椎体节段的胸腰椎脊柱手术的患者时，它可以安全替代芬太尼输注，以实现延长的镇痛效果且无任何阿片类药物相关的副作用。
