Koopredechat Piyawan, Chongarunngamsang Wanida, Kaweewong Manita, Thitipanichayankul Nattamon, Poonjan Salinee, Chanakul Thanyalak
Department of Anesthesiology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
BMC Anesthesiol. 2025 Aug 27;25(1):430. doi: 10.1186/s12871-025-03324-3.
The incidence of postoperative nausea and vomiting (PONV) has been reported to reach as high as 33.5% in patients undergoing abdominal surgeries. Intravenous dexmedetomidine has been shown to be effective in reducing the incidence of PONV, possibly through the inhibition of catecholamine release and decreased opioid requirements. This study aims to investigate the potential efficacy of epidural dexmedetomidine in preventing PONV in patients undergoing abdominal and pelvic surgery under combined general-epidural anesthesia.
The study enrolled patients aged 18-65 years with an ASA physical status I-III who were scheduled for elective open abdominal or pelvic surgery. Patients were randomized to receive either a single bolus dose of dexmedetomidine during peritoneal closure or placebo. No additional PONV prophylaxis was provided. Patients in the dexmedetomidine group received 2 mg of morphine combined with dexmedetomidine 1 mcg kg via the epidural catheter, whereas those in the placebo group received only morphine diluted to an equivalent volume.
Of the 108 patients randomized between August 2024 to April 2025, 99 were included in the final analysis. The incidence of PONV within 1 and 6 h postoperatively was significantly lower in the dexmedetomidine group compared to placebo (3.8% vs. 30.4%; RR 0.12, 95% CI 0.03-0.52, p < 0.001 and 13.2% vs. 32.6%, RR 0.41, 95% CI 0.18-0.91, p = 0.021), respectively. The severity of postoperative nausea was not different between the groups (p = 0.557). The incidence of postoperative shivering was significantly lower in the dexmedetomidine group (0% vs. 15.2%, p = 0.003).
A single administration of epidural dexmedetomidine at 1 mcg kg significantly reduced both the incidence of early PONV at 1 and 6 h postoperatively and postoperative shivering without increasing hemodynamic complications.
Retrospectively registered with Thai Clinical Trials Registry (TCTR20250331001) on 31 March 2025.
据报道，腹部手术患者术后恶心呕吐（PONV）的发生率高达33.5%。静脉注射右美托咪定已被证明可有效降低PONV的发生率，可能是通过抑制儿茶酚胺释放和减少阿片类药物需求。本研究旨在探讨硬膜外给予右美托咪定对接受全身 - 硬膜外联合麻醉的腹部和盆腔手术患者预防PONV的潜在疗效。
本研究纳入年龄在18 - 65岁、ASA身体状况为I - III级、计划行择期开放性腹部或盆腔手术的患者。患者被随机分为在腹膜关闭时接受单次推注右美托咪定或安慰剂组。未提供额外的PONV预防措施。右美托咪定组患者通过硬膜外导管接受2mg吗啡联合1μg/kg右美托咪定，而安慰剂组患者仅接受稀释至相同体积的吗啡。
在2024年8月至2025年4月随机分组的108例患者中，99例纳入最终分析。与安慰剂组相比，右美托咪定组术后1小时和6小时内PONV的发生率显著更低（分别为3.8%对30.4%；RR 0.12，95%CI 0.03 - 0.52，p < 0.001和13.2%对32.6%，RR 0.41，95%CI 0.18 - 0.91，p = 0.021）。两组术后恶心的严重程度无差异（p = 0.557）。右美托咪定组术后寒战的发生率显著更低（0%对15.2%，p = 0.003）。
硬膜外给予1μg/kg右美托咪定单次给药可显著降低术后1小时和6小时早期PONV的发生率以及术后寒战，且不增加血流动力学并发症。
于2025年3月31日在泰国临床试验注册中心（TCTR20250331001）进行回顾性注册。
