Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Pain Medicine, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People's Republic of China.
Drug Des Devel Ther. 2024 Oct 11;18:4551-4562. doi: 10.2147/DDDT.S475749. eCollection 2024.
Postoperative pain is a common yet often underestimated complication following esophageal endoscopic submucosal dissection (ESD), with limited strategies for effective management. This prospective, double-blind, randomized controlled trial assessed the effects of adding dexmedetomidine (DEX) to the anesthesia regimen on postoperative pain and early recovery in patients undergoing esophageal ESD.
In total, 60 patients scheduled for elective esophageal ESD under general anesthesia were randomly assigned to the DEX or control group. The DEX group received an intravenous loading dose of DEX at 1 μg/kg for 10 min, followed by a continuous intravenous infusion of 0.6 µg/kg/h, which was stopped 30 min before the end of the procedure. The control group received normal saline as a placebo. The study's primary outcome was the incidence of moderate-to-severe postoperative pain. Secondary outcomes included postoperative pain scores, hemodynamic parameters, the occurrence of postoperative nausea and vomiting (PONV), patient satisfaction, and lengths of stay in the post-anesthesia care unit (PACU) and hospital.
The incidence of moderate-to-severe postoperative pain in the DEX group was significantly lower than that in the control group (absolute difference: -33.4%; OR: 0.250; 95% CI: 0.085-0.731, = 0.01). Pain scores at 1 h postoperatively (0.5[2.0] 3.0[1.3], = 0.003) were significantly lower in the DEX group. Additionally, morphine dosage in the PACU (0[0] 1.0[2.0] = 0.004) was significantly reduced in the DEX group compared with the control group. In the DEX group, the incidence and severity of PONV were significantly decreased and the length of PACU stay was shorter than in the control group ( 0.01). However, the rates of intraoperative hypotension, tachycardia, and bradycardia were similar between the two groups. Patient satisfaction and length of hospital stay were also comparable.
Adding DEX to the anesthesia regimen for esophageal ESD significantly attenuates postoperative pain and improves early recovery outcomes.
术后疼痛是内镜下食管黏膜剥离术（ESD）后常见但常被低估的并发症，目前对于这种并发症的有效管理策略有限。本前瞻性、双盲、随机对照试验评估了在全身麻醉下接受食管 ESD 的患者中，在麻醉方案中添加右美托咪定（DEX）对术后疼痛和早期恢复的影响。
共纳入 60 例拟行择期全身麻醉下食管 ESD 的患者，随机分为 DEX 组或对照组。DEX 组静脉推注负荷剂量 1μg/kg 持续 10min，然后以 0.6μg/（kg·h）持续静脉输注，在手术结束前 30min 停止输注。对照组给予生理盐水作为安慰剂。本研究的主要结局是中重度术后疼痛的发生率。次要结局包括术后疼痛评分、血流动力学参数、术后恶心和呕吐（PONV）的发生、患者满意度以及麻醉后监护病房（PACU）和住院时间。
DEX 组中重度术后疼痛的发生率明显低于对照组（绝对差异：-33.4%；OR：0.250；95%CI：0.085-0.731， = 0.01）。术后 1h 时疼痛评分（0.5[2.0] 3.0[1.3]， = 0.003）DEX 组明显较低。此外，DEX 组 PACU 中吗啡用量（0[0] 1.0[2.0] = 0.004）明显低于对照组。DEX 组 PONV 的发生率和严重程度明显降低，PACU 停留时间也短于对照组（ 0.01）。然而，两组术中低血压、心动过速和心动过缓的发生率相似。患者满意度和住院时间也相当。
在食管 ESD 的麻醉方案中添加 DEX 可显著减轻术后疼痛并改善早期恢复结果。
