Hou Chunliu, Zhang Siming, Zhu Yuqing, Wen Guochun, Wang Guoran, Dai Jinxiang, Xu Fei, Li Chunjie, Chen Huiyi, Wang Di, Han Qingqing, Su Xuesen, Zhang Wenjie, Tian Shouyuan, Li Yan
Postgraduate Training Institute of Jizhou District People's Hospital,Tianjin Medical University, No. 18, Nanhuan Road, Jizhou District, Tianjin, 301900, People's Republic of China.
Tianjin University of Traditional Chinese Medicine, No. 10, Poyang Lake Road, West District, Tuanbo New Town, Jinghai District, Tianjin, 301607, People's Republic of China.
BMC Anesthesiol. 2025 Apr 17;25(1):187. doi: 10.1186/s12871-025-03038-6.
Colonoscopy is essential for diagnosing colon lesions but is often associated with discomfort. Painless colonoscopy techniques are being increasingly used to improve the patient experience."However, in the case of painless colonoscopy, anesthesia is performed outside the operating room, which requires more significant peri-examination of hemodynamic changes and adverse postoperative reactions. This requires a more careful selection of narcotic analgesics, and there needs to be optimal analgesic drug guidance in clinical practice. This study compared the efficacy and safety of nalbuphine and hydromorphone in improving patient comfort and maintaining hemodynamic stability during elective colonoscopy.
This prospective, randomized, double-blinded controlled trial included 72 adult patients (aged 18-65) who underwent sedation colonoscopy. The 72 patients were randomly divided into two groups using a computer-generated random sequence. Body mass index 18.5-28.0 kg/m2; American Society of Anesthesiologists (ASA) grade I to II. Then, the nalbuphine group was given 0.13 mg/kg nalbuphine, the hydromorphone group was given 0.016 mg/kg hydromorphone, and during the operation, 10-20 mg/time propofol could be appropriately injected according to the patient's examination and cooperation. All patients were continuously monitored for oxygen saturation, heart rate, and noninvasive mean arterial blood pressure. The colonoscopy time and anesthesia time were recorded. Adverse reactions such as hypotension, decreased oxygen saturation, nausea, and vomiting were recorded. Anesthesiologist satisfaction, gastroenterologist (operator), and patient satisfaction were recorded.
Both nalbuphine and hydromorphone effectively maintained hemodynamic stability, with no significant differences in vital signs observed between the groups (P > 0.05). However, nalbuphine significantly reduced the incidence of postoperative nausea, vomiting, dizziness, and headache compared to hydromorphone (P < 0.05). The reduced side effects of nalbuphine were marked, suggesting a better postoperative comfort profile.
While nalbuphine and hydromorphone effectively maintain intraoperative vital signs, nalbuphine offers superior postoperative comfort. This makes nalbuphine a preferable analgesic choice in outpatient colonoscopy settings. Further research is warranted to determine the optimal dosages for both drugs and to explore their mechanisms of action in procedural pain management.
ChiCTR2300077446,November 9, 2023.
结肠镜检查对于诊断结肠病变至关重要，但常伴有不适感。无痛结肠镜检查技术正越来越多地被用于改善患者体验。然而，在无痛结肠镜检查中，麻醉在手术室以外进行，这需要在检查期间对血流动力学变化和术后不良反应进行更全面的监测。这就需要更谨慎地选择麻醉性镇痛药，并且在临床实践中需要有最佳的镇痛药物指导。本研究比较了纳布啡和氢吗啡酮在择期结肠镜检查期间改善患者舒适度和维持血流动力学稳定性方面的疗效和安全性。
这项前瞻性、随机、双盲对照试验纳入了72例接受镇静结肠镜检查的成年患者（年龄18 - 65岁）。使用计算机生成的随机序列将这72例患者随机分为两组。体重指数18.5 - 28.0kg/m²；美国麻醉医师协会（ASA）分级为I至II级。然后，纳布啡组给予0.13mg/kg纳布啡，氢吗啡酮组给予0.016mg/kg氢吗啡酮，术中可根据患者的检查及配合情况适当追加丙泊酚10 - 20mg/次。持续监测所有患者的血氧饱和度、心率和无创平均动脉血压。记录结肠镜检查时间和麻醉时间。记录低血压、血氧饱和度下降、恶心、呕吐等不良反应。记录麻醉医师满意度、胃肠病学家（操作者）满意度和患者满意度。
纳布啡和氢吗啡酮均能有效维持血流动力学稳定性，两组间生命体征无显著差异（P>0.05）。然而，与氢吗啡酮相比，纳布啡显著降低了术后恶心、呕吐、头晕和头痛的发生率（P<0.05）。纳布啡的副作用减少明显，提示术后舒适度更好。
虽然纳布啡和氢吗啡酮均能有效维持术中生命体征，但纳布啡术后舒适度更佳。这使得纳布啡成为门诊结肠镜检查中更优的镇痛选择。有必要进一步研究以确定两种药物的最佳剂量，并探索它们在手术疼痛管理中的作用机制。
ChiCTR2300077446，2023年11月9日。
