The First Clinical Medical College of Gannan Medical University, Ganzhou, China.
Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
CNS Drugs. 2024 Jul;38(7):547-558. doi: 10.1007/s40263-024-01083-2. Epub 2024 Apr 4.
Percutaneous endoscopic transforaminal discectomy (PETD) is an effective method for treating lumbar disc herniation, and is typically performed under local anesthesia. However, inadequate analgesia during the procedure remains a concern, prompting the search for a medication that can provide optimal pain control with minimal impact on the respiratory and circulatory systems.
The aim of this study was to observe the effects of different doses of esketamine combined with dexmedetomidine on reducing visual analog scale (VAS) scores during surgical interventions.
One hundred two patients who underwent PETD were randomly divided into a control group (group C: normal saline + dexmedetomidine), an E1 group (0.1 mg kg esketamine + dexmedetomidine), and an E2 group (0.2 mg kg esketamine + dexmedetomidine). The primary outcome was the maximum visual analogue scale (VAS) (score: 0 = no pain and 10 = worst pain) at six time points. The secondary outcomes included the Assessment of Alertness/Sedation Scale (OAA/S) score and mean arterial pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO) at 11 time points. The incidence of adverse reactions during and 24 h after the operation and patient satisfaction with the anesthesia were also recorded.
Compared with those in group C, the VAS scores of patients in groups E1 and E2 were lower at T, T, and T (P < 0.05). From T to T, the OAA/S scores of the E1 and E2 groups were both lower than those of group C (P < 0.05), and at the T-T time points, the OAA/S score of the E2 group was lower than that of group E1 (P < 0.05). At T and T, the HR and BP of patients in groups E1 and E2 were greater than those in group C (P < 0.05). Compared with those in group C, the incidences of intraoperative illusion, floating sensation, postoperative dizziness, and hyperalgesia in groups E1 and E2 were significantly greater (P < 0.01). There was no significant difference in patient RR, SpO, or postoperative satisfaction with anesthesia among the three groups (P > 0.05).
The combination of esketamine and dexmedetomidine can reduce VAS scores during certain stages of this type of surgery; it has minimal impact on respiration and circulation. However, this approach is associated with increased incidences of postoperative dizziness and psychiatric side effects, which may also affect patients' compliance with surgical instructions from medical staff. Patient satisfaction was not greater with dexmedetomidine combined with esketamine than with dexmedetomidine alone.
http://www.chictr.org.cn . Identifier: ChiCTR2300068206. Date of registration: 10 February 2023.
经皮内镜椎间孔入路椎间盘切除术（PETD）是治疗腰椎间盘突出症的有效方法，通常在局部麻醉下进行。然而，术中镇痛不足仍然是一个关注点，这促使人们寻找一种既能提供最佳疼痛控制又能最小化对呼吸和循环系统影响的药物。
本研究旨在观察不同剂量的依托咪酯与右美托咪定联合应用对降低手术干预时视觉模拟评分（VAS）的影响。
102 例行 PETD 的患者随机分为对照组（C 组：生理盐水+右美托咪定）、E1 组（0.1mg/kg 依托咪酯+右美托咪定）和 E2 组（0.2mg/kg 依托咪酯+右美托咪定）。主要结局为 6 个时间点的最大视觉模拟评分（VAS）（评分：0=无痛，10=最痛）。次要结局包括警觉/镇静评分（OAA/S）和平均动脉压（BP）、心率（HR）、呼吸频率（RR）和氧饱和度（SpO）在 11 个时间点的变化。还记录了术中及术后 24h 不良反应的发生情况及患者对麻醉的满意度。
与 C 组相比，E1 组和 E2 组患者在 T、T 和 T 时的 VAS 评分均较低（P<0.05）。从 T 到 T，E1 组和 E2 组的 OAA/S 评分均低于 C 组（P<0.05），且在 T-T 时间点，E2 组的 OAA/S 评分低于 E1 组（P<0.05）。在 T 和 T 时，E1 组和 E2 组患者的 HR 和 BP 均高于 C 组（P<0.05）。与 C 组相比，E1 组和 E2 组术中幻觉、漂浮感、术后头晕和痛觉过敏的发生率明显更高（P<0.01）。三组患者的 RR、SpO 和术后麻醉满意度无显著差异（P>0.05）。
依托咪酯与右美托咪定联合应用可降低此类手术某些阶段的 VAS 评分，对呼吸和循环的影响较小。但这一方法与术后头晕和精神副作用的发生率增加有关，这可能会影响患者对医务人员手术医嘱的依从性。依托咪酯与右美托咪定联合应用的患者满意度并不高于右美托咪定单独应用。
http://www.chictr.org.cn。标识符：ChiCTR2300068206。注册日期：2023 年 2 月 10 日。
