机器人辅助膀胱切除术术中应用美沙酮对术后阿片类药物需求的影响：一项随机临床试验。

Effect of intraoperative methadone in robot-assisted cystectomy on postoperative opioid requirements: A randomized clinical trial.

机构信息

Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.

Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

出版信息

Acta Anaesthesiol Scand. 2025 Jan;69(1):e14545. doi: 10.1111/aas.14545.

DOI:10.1111/aas.14545

PMID:39508073

Abstract

BACKGROUND

Postoperative pain management is a challenge after robot-assisted cystectomy (RAC). Methadone has a long duration of action, and we therefore hypothesized that a single dose of intraoperative methadone would reduce postoperative opioid requirements and pain intensity in bladder cancer patients undergoing RAC.

METHODS

We conducted a blinded randomized controlled clinical trial from July 2020 to August 2023. Patients scheduled to undergo RAC because of bladder cancer were randomized to receive intraoperative methadone (0.15 mg/kg) or morphine (0.15 mg kg) 1 h before endotracheal extubation. The primary outcome was opioid requirements after 24 h. Secondary outcomes were opioid requirements after 3 h, pain intensity at rest and during coughing, postoperative nausea and vomiting (PONV), sedation, hypoxemia, hypoventilation, time spent in the post-anesthetic care unit, and patient satisfaction.

RESULTS

A total of 114 patients were randomized. Data from 99 patients (14 females, 85 males; mean age 69.8 ± 8.9 years) were available for analysis; 52 received methadone and 47 received morphine. Opioid consumption was similar between the methadone group and morphine group at 3 h (median, mg, 45 (IQR 30 to 75) vs. 45 (IQR 15 to 82.5) p = .97) and at 24 h (median, mg, 125 (IQR 75 to 198.5) versus 105 (IQR 72 to 157.5), p = .29). Pain intensity was significantly lower in the morphine group at 48 h compared with the methadone group. Patient satisfaction at 24 h was increased in the methadone group compared with the morphine group (median, (IQR), NRS; 9 (IQR 7 to 10) versus 7 (IQR 4 to 9), p = .020). There were no differences between treatment groups in terms of time spent in the post-anesthetic care unit and the occurrence of opioid-related side effects.

CONCLUSION

A single dose of intraoperative methadone does not reduce postoperative opioid requirements compared with a single dose of morphine in bladder cancer patients undergoing RAC.

摘要

背景

机器人辅助膀胱切除术（RAC）后，术后疼痛管理是一个挑战。美沙酮作用时间长，因此我们假设在气管拔管前 1 小时给予单次剂量的术中美沙酮可减少接受 RAC 的膀胱癌患者术后阿片类药物的需求和疼痛强度。

方法

我们进行了一项从 2020 年 7 月至 2023 年 8 月的盲法随机对照临床试验。因膀胱癌接受 RAC 治疗的患者被随机分为接受术中美沙酮（0.15mg/kg）或吗啡（0.15mg·kg）组，在气管拔管前 1 小时给予。主要结局是 24 小时后阿片类药物的需求。次要结局是术后 3 小时的阿片类药物需求、静息和咳嗽时的疼痛强度、术后恶心和呕吐（PONV）、镇静、低氧血症、低通气、在麻醉后护理单元停留的时间和患者满意度。

结果

共有 114 名患者被随机分配。99 名患者（14 名女性，85 名男性；平均年龄 69.8±8.9 岁）的数据可用于分析；52 名患者接受美沙酮治疗，47 名患者接受吗啡治疗。在术后 3 小时（中位数，mg，45（IQR 30 至 75）与 45（IQR 15 至 82.5），p=0.97）和术后 24 小时（中位数，mg，125（IQR 75 至 198.5）与 105（IQR 72 至 157.5），p=0.29），美沙酮组和吗啡组的阿片类药物消耗相似。与美沙酮组相比，吗啡组在术后 48 小时的疼痛强度明显更低。与吗啡组相比，美沙酮组在术后 24 小时的患者满意度更高（中位数，（IQR），NRS；9（IQR 7 至 10）与 7（IQR 4 至 9），p=0.020）。两组患者在麻醉后护理单元停留时间和阿片类药物相关副作用的发生方面没有差异。