Friesgaard Kristian D, Brix Lone D, Kristensen Christina B, Rian Omar, Nikolajsen Lone
Department of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark.
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
BJA Open. 2023 Aug 5;7:100219. doi: 10.1016/j.bjao.2023.100219. eCollection 2023 Sep.
Laparoscopic hysterectomy is often carried out as day-stay surgery. Minimising postoperative pain is therefore of utmost importance to ensure timely discharge from hospital. Methadone has several desirable pharmacological features, including a long elimination half-life. Therefore, a single intraoperative dose could provide long-lasting pain relief.
Patients scheduled to undergo laparoscopic hysterectomy were randomly allocated to receive methadone (0.2 mg kg) or morphine (0.2 mg kg) intraoperatively, 60 min before tracheal extubation. Primary outcomes were opioid consumption (oral morphine equivalents in milligrams) at 6 and 24 h. Secondary outcomes included pain intensity at rest and during coughing, patient satisfaction, postoperative nausea and vomiting, and adverse events up to 72 h after completion of surgery.
The postoperative median opioid consumption was reduced in the methadone group compared with the morphine group at 6 h (35.5 [0-61] mg 48 [31-74.5] mg; =0.01) and 24 h (42 [10-67] mg 54.5 [31-83] mg; =0.03). On arrival at the PACU, pain at rest was significantly lower in patients receiving methadone (numeric rating scale: 3 [2-5] 5 [3-6]), whereas pain scores at rest and coughing were not significantly different throughout the rest of the observation period. No differences in other secondary outcomes were found.
In this randomised, blinded, controlled trial, opioid consumption was reduced during the first 24 postoperative hours in patients receiving methadone without causing an increase in adverse events. The difference observed might be considered as small and of limited clinical relevance.
NCT03908060; EudraCT no. 2018-004351-20.
腹腔镜子宫切除术通常作为日间手术进行。因此，将术后疼痛降至最低对于确保及时出院至关重要。美沙酮具有多种理想的药理学特性，包括较长的消除半衰期。因此，术中单次给药即可提供持久的疼痛缓解。
计划接受腹腔镜子宫切除术的患者被随机分配在气管拔管前60分钟术中接受美沙酮（0.2毫克/千克）或吗啡（0.2毫克/千克）。主要结局指标为术后6小时和24小时的阿片类药物消耗量（以毫克为单位的口服吗啡当量）。次要结局指标包括静息和咳嗽时的疼痛强度、患者满意度、术后恶心和呕吐以及术后72小时内的不良事件。
与吗啡组相比，美沙酮组术后6小时（35.5[0 - 61]毫克对48[31 - 74.5]毫克；P = 0.01）和24小时（42[10 - 67]毫克对54.5[31 - 83]毫克；P = 0.03）的阿片类药物消耗量中位数降低。到达麻醉后恢复室时，接受美沙酮的患者静息时疼痛明显较轻（数字评分量表：3[2 - 5]对5[3 - 6]），而在其余观察期内静息和咳嗽时的疼痛评分无显著差异。未发现其他次要结局指标存在差异。
在这项随机、双盲、对照试验中，接受美沙酮的患者术后24小时内阿片类药物消耗量减少，且未导致不良事件增加。观察到的差异可能被认为较小且临床相关性有限。
NCT03908060；欧盟临床试验编号2018 - 004351 - 20。
