Nam Sun Woo, Do Sang-Hwan, Hwang Jung-Won, Park Insun, Hwang Insung, Na Hyo-Seok
Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Anesthesiol. 2024 Dec;77(6):605-613. doi: 10.4097/kja.24336. Epub 2024 Aug 23.
In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery.
Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day 1.
A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups.
OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.
在本研究中，我们旨在调查阿片类药物节省麻醉（OSA）是否能降低接受腹腔镜妇科手术患者的术后恶心和呕吐（PONV）发生率。
将接受择期腹腔镜妇科手术的成年患者随机分为使用阿片类药物麻醉（OUA）组或OSA组。在OUA组中，瑞芬太尼在全身麻醉期间作为阿片类药物使用。在OSA组中，除了气管插管时单次给予5μg/kg的阿芬太尼外，未使用其他阿片类药物。在两组中，麻醉后护理单元（PACU）优先使用多模式静脉非阿片类镇痛方案。主要结局是PONV的发生率，通过术后第1天的症状进行评估。
本研究共纳入120例患者。与OUA组相比，OSA组在PACU中的恶心发生率显著更低（OSA组为31.7%，OUA组为51.7%，P = 0.026）。在PACU停留期间，OSA组的疼痛评分和阿片类镇痛药物的使用发生率更低，导致需要急救阿片类镇痛药物的患者数量显著更少（3.3%对18.3%，P = 0.008）。两组在术中生命体征、血流动力学干预或PACU停留时间和住院时间方面无显著差异。
OSA显著降低了接受腹腔镜妇科手术患者的术后恶心、疼痛评分以及PACU中对急救镇痛药物的需求，且未增加血流动力学不稳定。
