甲状腺切除术患者术中单次静脉注射右美托咪定对瑞芬太尼诱发的输注后痛觉过敏的影响：一项双盲随机对照试验

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甲状腺切除术患者术中单次静脉注射右美托咪定对瑞芬太尼诱发的输注后痛觉过敏的影响：一项双盲随机对照试验

翻译：何幼芹  编辑：冯玉蓉  审校：曹莹

背景及目的： 

麻醉期间持续泵注大剂量瑞芬太尼可导致瑞芬太尼诱发的输注后痛觉过敏(RPH)。右美托咪定是一种高选择性的α2-肾上腺素能受体激动剂，可能与阿片类药物有协同作用，有助于围术期疼痛管理。本研究中，我们假设术中单次静脉注射右美托咪定可缓解全麻下甲状腺切除术患者的RPH。

方法： 

将90例行甲状腺切除术患者随机分为3组：生理盐水安慰剂组（P组）；低剂量右美托咪定组（0.2 μg·kg-1）（LD组）；大剂量右美托咪定组（0.5 μg·kg-1）（HD组）。瑞芬太尼以0.3 μg·kg-1·min-1的速率进行输注。使用电子Von Frey测痛仪测量术前、术后30 min、6 h、24 h和48 h机械疼痛阈值，并采用双向重复测量方差分析(ANOVA)和Bonferroni 事后比较进行分析。记录患者术后疼痛评分、需要紧急镇痛的频率以及术后48 h内的副作用。

结果：

术后30 min和6 h，LD组切口周围的机械疼痛阈值明显高于P组（30 min时，均数±标准差：[65.0±25.2]vs[49.6±24.4]g，均数差[95 % CI]：15.4[0.3-30.5] g，P=0.045；6 h时，[65.9±24.5]vs[49.3±26.1]g，16.6[1.1-32.1] g，P=0.032）。术后30 min和6 h，HD组皮肤切口周围疼痛阈值明显高于P组（30 min时，[67.8 ± 21.7] vs [49.6 ± 24.4] g, 18.2 [3.1-33.3] g, P=0 .013 ; 6 h时，[68.3 ± 22.5] vs [49.3 ± 26.1] g, 19.0 [3.5-34.5] g, P=0 .011）。术后30 min和6 h，HD组切口周围痛觉过敏发生率低于P组 (30 min时，4 [13%] vs 14 [48%], P= 0.012 ；6 h时，4 [13%] vs 12 [41%], P=0 .045)，但LD组与P组无显著差异。各组间患者术后疼痛评分、需紧急镇痛的频率及术后副作用无显著性差异。

结论： 术中单次静脉注射0.5 μg·kg-1右美托咪定可减轻瑞芬太尼引起的甲状腺切除术患者的痛觉过敏，且不增加不良反应的发生率。

原始文献来源：

Wu Z, Yu J, Lin Q, et al. Effects of an Intraoperative Intravenous Bolus Dose of Dexmedetomidine on Remifentanil-Induced Postinfusion Hyperalgesia in Patients Undergoing Thyroidectomy: A Double-Blind Randomized Controlled Trial[J] .Anesth. Analg, 2020, undefined: undefined.

Effects of an Intraoperative Intravenous Bolus Dose of Dexmedetomidine on Remifentanil-Induced Postinfusion Hyperalgesia in Patients Undergoing Thyroidectomy: A Double-Blind Randomized Controlled Trial

Abstract

BACKGROUND:Consecutive exposure to high-dose remifentanil during anesthesia may induce remifentanil-induced postinfusion hyperalgesia (RPH). Dexmedetomidine, a highly selective α2-adrenergic receptor agonist, may have synergistic effects with opioids and aid in perioperative pain management. In this study, we hypothesized that an intraoperative bolus dose of intravenous dexmedetomidine could alleviate RPH in patients undergoing thyroidectomy under general anesthesia.

METHODS:Ninety patients undergoing thyroidectomy were randomly assigned to 1 of 3 groups: placebo, normal saline (group P); low-dose dexmedetomidine 0.2 μg·kg (group LD); or high-dose dexmedetomidine 0.5 μg·kg (group HD). Remifentanil was infused at a rate of 0.30 μg·kg-1·minute-1. Mechanical pain thresholds were measured using an Electronic von Frey device preoperatively and at 30 minutes, 6 hours, 24 hours, and 48 hours after surgery and were analyzed with 2-way repeated-measures analysis of variance (ANOVA) followed by Bonferroni post hoc comparison. We also recorded postoperative pain scores, the incidence of receiving rescue analgesics, and side effects up to 48 hours after surgery.

RESULTS:The mechanical pain thresholds around the skin incision were significantly higher in group LD compared to group P 30 minutes and 6 hours after surgery (mean ± standard deviation: [65.0 ± 25.2] vs [49.6 ± 24.4] g, mean difference [95% confidence interval]: 15.4 [0.3-30.5] g, P=0 .045 at 30 minutes; [65.9 ± 24.5] vs [49.3 ± 26.1] g, 16.6 [1.1-32.1] g, P=0 .032 at 6 hours). The pain thresholds around the skin incision were significantly higher in group HD compared to group P 30 minutes and 6 hours after surgery ([67.8 ± 21.7] vs [49.6 ± 24.4] g, 18.2 [3.1-33.3] g, P= 0.013 at 30 minutes; [68.3 ± 22.5] vs [49.3 ± 26.1] g, 19.0 [3.5-34.5] g, P=0 .011 at 6 hours). The incidence of hyperalgesia around the skin incision was lower in group HD than in group P 30 minutes and 6 hours after surgery (4 [13%] vs 14 [48%], P=0 .012 at 30 minutes, 4 [13%] vs 12 [41%], P= 0.045 at 6 hours), although no significant difference was observed between group LD and group P. Postoperative pain scores, the incidence of rescue analgesic demand, and postoperative side effects were not significantly different between the groups.

CONCLUSIONS:An intraoperative intravenous bolus dose of dexmedetomidine 0.5 μg·kg alleviates remifentanil-induced hyperalgesia in patients undergoing thyroidectomy without a significant difference in side effects.