关节镜下颞下颌关节手术患者的术中非阿片类麻醉：一项随机对照试验。

Intraoperative Non-Opiate Anesthesia for Patients Undergoing Arthroscopic Temporomandibular Joint Surgery: A Randomized Controlled Trial.

机构信息

Department of Anesthesiology, the Second Hospital of Jilin University, Changchun, People's Republic of China.

Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Drug Des Devel Ther. 2024 Nov 4;18:4915-4925. doi: 10.2147/DDDT.S486134. eCollection 2024.

DOI:10.2147/DDDT.S486134

PMID:39525049

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11546274/

Abstract

BACKGROUND

Pain intensity after temporomandibular joint (TMJ) surgery is often underestimated, and inadequate pain control may relate to poor recovery quality, increased opioid consumption, and longer hospital stay. This trial aims to evaluate whether non-opiate anesthesia provides a promising option of pain management for patients undergoing TMJ surgery.

METHODS

Sixty patients receiving TMJ surgery were randomly assigned to either the control group or the non-opiate group. Non-opiate anesthesia used lidocaine, dexmedetomidine, and ketamine infusion therapy for pain management. The primary outcome was the highest documented pain score while in the post-anesthesia care unit (PACU). Secondary outcomes included perioperative opioid consumption, utilization, dosage, and timing of rescue analgesia in the PACU, incidence of postoperative nausea and vomiting in the PACU and at home, pain satisfaction levels, occurrence of opioid-related adverse effects, duration of PACU and hospital stays, and total consumption of oxycodone-acetaminophen tablets at 24 and 48 hours post-surgery.

RESULTS

Patients were predominantly female (88.3%) and had a median age of 37.5 [IQR 26.0, 52.5] years. There were no significant differences observed in the highest documented pain scores (mean difference [MD] -0.36 points, 95% CI: -1.84, 1.12, p = 0.63), postoperative oxycodone-acetaminophen consumption (MD 6.68 mg, 95% CI: -2.48, 15.84, p = 0.15), pain satisfaction (odds ratio [OR] 0.81, 95% CI: 0.23, 2.81, p = 0.74), time to PACU discharge (hazard ratio [HR] 1.24, 95% CI: 0.67, 2.30, p = 0.49) or time to hospital discharge (HR 1.48, 95% CI: 0.80, 2.75, p = 0.21) between the two groups. Similarly, no significant difference was observed in time to rescue analgesia, calculated in minutes from the end of surgery (HR 1.69, 95% CI: 0.79, 3.61, p = 0.18).

CONCLUSION

Non-opiate anesthesia for pain management shows a similar postoperative analgesia effect, compared to opioid-based anesthesia, in patients undergoing arthroscopic TMJ surgery.

摘要

背景

颞下颌关节（TMJ）手术后的疼痛强度常常被低估，而疼痛控制不足可能与恢复质量差、阿片类药物消耗增加和住院时间延长有关。本试验旨在评估非阿片类麻醉是否为 TMJ 手术患者提供了一种有前途的疼痛管理选择。

方法

60 例接受 TMJ 手术的患者被随机分配至对照组或非阿片类组。非阿片类麻醉采用利多卡因、右美托咪定和氯胺酮输注疗法进行疼痛管理。主要结局为麻醉后护理单元（PACU）中记录的最高疼痛评分。次要结局包括围手术期阿片类药物消耗、使用、剂量和 PACU 中解救镇痛的时间、PACU 和家中术后恶心和呕吐的发生率、疼痛满意度水平、阿片类相关不良反应的发生、PACU 和住院时间以及术后 24 和 48 小时时羟考酮-对乙酰氨基酚片的总消耗量。

结果

患者主要为女性（88.3%），中位年龄为 37.5 [IQR 26.0, 52.5] 岁。两组记录的最高疼痛评分（平均差异[MD] -0.36 分，95%CI：-1.84, 1.12，p = 0.63）、术后羟考酮-对乙酰氨基酚消耗量（MD 6.68 mg，95%CI：-2.48, 15.84，p = 0.15）、疼痛满意度（比值比[OR] 0.81，95%CI：0.23, 2.81，p = 0.74）、PACU 出院时间（风险比[HR] 1.24，95%CI：0.67, 2.30，p = 0.49）或住院时间（HR 1.48，95%CI：0.80, 2.75，p = 0.21）之间均无显著差异。同样，从手术结束到解救镇痛的时间（HR 1.69，95%CI：0.79, 3.61，p = 0.18），以分钟计算，两组之间也无显著差异。