小儿腹腔镜手术中吗啡与纳布啡术后镇痛及副作用的比较
Comparison of postoperative analgesia and side effects in pediatric laparoscopic surgery with morphine and nalbuphine.
作者信息
Chen Jia, Wang Cheng-Yu, Zhong John Wei, Cai Yu-Hang, Zhang Jianmin, Wang Fang, Zhang Mazhong, Gu Hongbin, Ma Hong-Yu, Wang Zhen, Wu Junzheng, Liu Hua-Cheng
机构信息
Department of Anaesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University; Key Laboratory of Paediatric Anaesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anaesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Centre, Dallas, TX, USA.
出版信息
iScience. 2024 Feb 20;27(3):109287. doi: 10.1016/j.isci.2024.109287. eCollection 2024 Mar 15.
There is currently no consensus on the optimal perioperative pain management strategy involving specific opioids. This study aims to compare the postoperative analgesia, the associated side effects between nalbuphine and morphine in children undergoing laparoscopic surgery. One hundred ninety children were randomly assigned to nalbuphine (0.2 mg/kg) or morphine (0.2 mg/kg). Nalbuphine's analgesic effect was non-inferior to morphine, with similar total rescue analgesic consumption during PACU stay (0.03 ± 0.05mg vs. 0.04 ± 0.06 mg, p > 0.05). Nalbuphine group had a lower incidence of respiratory depression (RR ≤ 10/min) (4.8% vs. 38.6%, p < 0.001), PONV (2.4% vs. 18.1%, p = 0.002), and pruritus (0% vs. 16.9%, p < 0.001) than morphine. Additionally, nalbuphine showed a shorter laryngeal mask airway removal time (13.9 [12.7, 15.1]) compared with morphine (17.0 [15.1, 18.9], p = 0.011). Nalbuphine provides equipotent analgesia with significantly lower incidences of respiratory depression, PONV, and pruritus compared with morphine in pediatric laparoscopic surgery.
目前，关于涉及特定阿片类药物的最佳围手术期疼痛管理策略尚无共识。本研究旨在比较纳布啡和吗啡在接受腹腔镜手术儿童中的术后镇痛效果及相关副作用。190名儿童被随机分为纳布啡组（0.2mg/kg）或吗啡组（0.2mg/kg）。纳布啡的镇痛效果不劣于吗啡，在麻醉后恢复室（PACU）停留期间的总补救镇痛药物消耗量相似（0.03±0.05mg对0.04±0.06mg，p>0.05）。纳布啡组呼吸抑制（RR≤10/分钟）、恶心呕吐（PONV）和瘙痒的发生率低于吗啡组（分别为4.8%对38.6%，p<0.001；2.4%对18.1%，p=0.002；0%对16.9%，p<0.001）。此外，与吗啡组（17.0[15.1,18.9]）相比，纳布啡组的喉罩拔除时间更短（13.9[12.7,15.1]）（p=0.011）。在小儿腹腔镜手术中，与吗啡相比，纳布啡提供同等镇痛效果，且呼吸抑制、PONV和瘙痒的发生率显著更低。
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