Ibrahim Eman Sayed, Metwally Ahmed A, Abdullatif Mohamed, Eid Essam A, Mousa Mahmoud G, Sultan Amany A
Department of Anaesthesiology, Intensive Care and Pain Management, National Liver Institute - Menoufia University, Menoufia, Egypt.
Intensive Care and Pain Management, National Liver Institute - Menoufia University, Menoufia, Egypt.
BMC Anesthesiol. 2025 Feb 1;25(1):53. doi: 10.1186/s12871-025-02915-4.
Opioid metabolism and pharmacodynamics may be affected in hepatic patients. Ketamine and dexmedetomidine are conventional anesthetics used in our daily practice. The opioid-sparing effects of this combination have not been evaluated in patients with liver cirrhosis undergoing liver resection. We aimed to investigate the potential peri-operative opioid-sparing effects of intra-operative dexmedetomidine and ketamine infusions in patients with Child A liver cirrhosis undergoing liver resection.
This study was a randomized controlled double-blind trial. 92 adult patients of both sex with Child class (A) liver cirrhosis aged 18 to 65 years entering and completing the study. We excluded patients with renal or cardiac dysfunction or contraindications from study medications.46 patients in the opioid-sparing group (OS) receiving ketamine and dexmedetomidine infusions and 46 patients in the opioid-based (OB) group as controls. The main outcome measures: were intra-operative fentanyl requirements, postoperative fentanyl requirements, visual analogue pain scores, postoperative nausea, vomiting, ileus, desaturation, intra-operative hemodynamic events, and ICU stay were recorded.
The total intra-operative fentanyl consumption was significantly lower in the OS group compared with the OB group, 183.2 ± 35.61 µg and 313.5 ± 75.06 µg, respectively, P < 0.001. The postoperative 1st 48 h fentanyl consumption was significantly lower in the OS group compared with the OB group, 354.5 ± 112.62 µg and 779.1 ± 294.97 ± µg, respectively, P < 0.001. Visual analogue scores were significantly better in the OS group at the early 2-hour assessment point postoperatively. The postoperative adverse events were significantly more frequent in the opioid-based group. ICU stay was significantly shorter in the OS group.
Administering dexmedetomidine and ketamine infusions intra-operatively to patients with Child A liver cirrhosis undergoing liver resection resulted in notable opioid-sparing effects, with reductions of approximately 40% intra-operatively and 55% postoperatively. The opioid-sparing group exhibited improved postoperative outcomes, including reduced pain, decreased incidence of opioid-related side effects and shorter ICU stays.
肝脏疾病患者的阿片类药物代谢及药效动力学可能受到影响。氯胺酮和右美托咪定是我们日常临床中常用的麻醉药。尚未对肝硬化患者肝切除术中使用这两种药物联用所产生的阿片类药物节省效应进行评估。我们旨在研究术中输注右美托咪定和氯胺酮对Child A级肝硬化行肝切除术患者围手术期阿片类药物节省效应的潜在影响。
本研究为随机对照双盲试验。92例年龄在18至65岁之间、符合Child A级肝硬化的成年患者纳入并完成了本研究。我们排除了有肾功能或心功能障碍或对研究药物有禁忌证的患者。46例患者进入阿片类药物节省组（OS组），接受氯胺酮和右美托咪定输注，46例患者进入基于阿片类药物组（OB组）作为对照。记录主要观察指标：术中芬太尼需求量、术后芬太尼需求量、视觉模拟疼痛评分、术后恶心、呕吐、肠梗阻、血氧饱和度下降、术中血流动力学事件以及重症监护病房（ICU）住院时间。
OS组术中芬太尼总消耗量显著低于OB组，分别为183.2±35.61μg和313.5±75.06μg，P<0.001。OS组术后48小时内芬太尼消耗量显著低于OB组，分别为354.5±112.62μg和779.1±294.97μg，P<0.001。术后2小时早期评估点时，OS组的视觉模拟评分明显更好。基于阿片类药物组术后不良事件发生频率显著更高。OS组的ICU住院时间显著更短。
对于Child A级肝硬化行肝切除术的患者，术中输注右美托咪定和氯胺酮可产生显著的阿片类药物节省效应，术中减少约40%，术后减少约55%。阿片类药物节省组术后结局得到改善，包括疼痛减轻、阿片类药物相关副作用发生率降低以及ICU住院时间缩短。
