鞘内注射氯胺酮-右美托咪定复合局部浸润麻醉与丙泊酚-瑞芬太尼靶控输注静脉麻醉在肩关节镜手术中应用的前瞻性随机对照研究

Opioid-free anesthesia with esketamine-dexmedetomidine versus opioid-based anesthesia with propofol-remifentanil in shoulder arthroscopy: a randomized controlled trial.

机构信息

Department of Anesthesiology, The Yancheng Clinical College of Xuzhou Medical University, No. 166 West Yulong Road, Yancheng, Jiangsu, 224001, China.

Department of Anesthesiology, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China.

出版信息

BMC Surg. 2024 Aug 10;24(1):228. doi: 10.1186/s12893-024-02518-9.

DOI:10.1186/s12893-024-02518-9

PMID:39127614

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11316359/

Abstract

BACKGROUND

OFA (Opioid-free anesthesia) has the potential to reduce the occurrence of opioid-related adverse events and enhance postoperative recovery. Our research aimed to investigate whether OFA, combining esketamine and dexmedetomidine, could serve as an alternative protocol to traditional OBA (opioid-based anesthesia) in shoulder arthroscopy, particularly in terms of reducing PONV (postoperative nausea and vomiting).

METHODS

A total of 60 patients treated with shoulder arthroscopy from September 2021 to September 2022 were recruited. Patients were randomly assigned to the OBA group (n = 30) and OFA group (n = 30), receiving propofol-remifentanil TIVA (total intravenous anesthesia) and esketamine-dexmedetomidine intravenous anesthesia, respectively. Both groups received ultrasound-guided ISBPB(interscalene brachial plexus block)for postoperative analgesia.

RESULTS

The incidence of PONV on the first postoperative day in the ward (13.3% vs. 40%, P < 0.05) was significantly lower in the OFA group than in the OBA group. Moreover, the severity of PONV was less severe in the OFA group than in the OBA group in PACU (post-anesthesia care unit) (0 [0, 0] vs. 0 [0, 3], P<0.05 ) and in the ward 24 h postoperatively ( 0 [0, 0] vs. 0 [0, 2.25], P<0.05). Additionally, the OFA group experienced a significantly shorter length of stay in the PACU compared to the OBA group (39.4 ± 6.76 min vs. 48.7 ± 7.90 min, P < 0.001).

CONCLUSIONS

Compared to the OBA with propofol-remifentanil, the OFA with esketamine- dexmedetomidine proved to be feasible for shoulder arthroscopy, resulting in a reduced incidence of PONV and a shorter duration of stay in the PACU.

TRIAL REGISTRATION

The Chinese Clinical Trial Registry (No: ChiCTR2100047355), 12/06/2021.

摘要

背景

OFA（无阿片麻醉）有可能减少阿片类药物相关不良事件的发生，并促进术后恢复。我们的研究旨在探讨 Esk 联合右美在肩关镜手术中是否可以替代传统 OBA（阿片类药物为基础的麻醉），特别是在减少术后恶心和呕吐（PONV）方面。

方法

共纳入 2021 年 9 月至 2022 年 9 月收治的行肩关镜手术的 60 例患者。患者随机分为 OBA 组（n=30）和 OFA 组（n=30），分别接受异丙酚-瑞芬太尼 TIVA（全凭静脉麻醉）和 Esk-右美静脉麻醉。两组均行超声引导下 ISBPB（肌间沟臂丛神经阻滞）用于术后镇痛。

结果

术后第 1 天病房 PONV 的发生率（13.3% vs. 40%，P<0.05）OFA 组明显低于 OBA 组。此外，OFA 组在 PACU（术后麻醉恢复室）（0[0，0] vs. 0[0，3]，P<0.05）和术后 24 h 病房（0[0，0] vs. 0[0，2.25]，P<0.05）的 PONV 严重程度也较轻。此外，与 OBA 组相比，OFA 组在 PACU 的停留时间明显缩短（39.4±6.76 min vs. 48.7±7.90 min，P<0.001）。