术中用的S-氯胺酮，还影响一年后......

摘要译文

术中使用S-氯胺酮降低脊柱手术后一年阿片类药物消耗量并减轻疼痛程度：一项针对阿片类依赖患者的随机临床试验

1背景：

我们的目的是探讨术中使用S-氯胺酮对接受脊柱融合术的慢性阿片依赖患者术后1年的镇痛药消耗和疼痛的影响。

2方法：

单中心、随机、盲法试验、共147例病例。

3干预：

围手术期给予S-氯胺酮负荷剂量0.5mg/kg，然后给予S-氯胺酮0.25mg/kg/hr或安慰剂。

4主要结局：

通过书面问卷调查评估术后一年的镇痛药使用量、疼痛程度（视觉模拟量表0-100 mm[VAS]）和劳动力市场依恋度。

5结果：

随访回应率为67%。术后一年中：

▶氯胺酮组与安慰剂组相比，每日口服吗啡等效物的用量较低：0（0-20）mg与20（0-62）mg，（p=0.02）。

▶氯胺酮组与安慰剂组相比，每日使用任何一种镇痛药的患者比例较少，分别为42%（95%CI 23-61）与74%（95%CI 58-87），（p=0.04）。

▶与安慰剂组相比，氯胺酮组的活动性疼痛更低：中位数差异为17 mm（95%CI：-30至-3），（p=0.02）。

▶与安慰剂组相比，氯胺酮组的静息痛更低，中位数差异为13mm（95%CI：-23至-3），（p=0.01）。

▶氯胺酮组的劳动力市场依恋度更好（p=0.02）。

6结论：

在慢性阿片类药物依赖人群中，术中使用氯胺酮可减少术后1年的镇痛药使用量，减轻疼痛，改善劳动力市场依恋度。

7意义：

这项随机临床试验表明，术中使用氯胺酮可减少阿片类药物的使用量和减轻疼痛程度，并改善阿片类药物依赖人群脊柱手术后一年的劳动力市场依恋度。

原文摘要 

IntraoperativeS-ketamine for the reduction of opioid consumption and pain one year afterspine surgery: A randomized clinical trial of opioid-dependent patients

Background: Weaimed to explore the effect of intraoperative S-ketamine on analgesicconsumption and pain one year after spine surgery in chronic opioid-dependentpatients undergoing spinal fusion surgery.

Methods: Single-centre,randomized, blinded trial of 147 patients.

Intervention: PerioperativeS-ketamine bolus 0.5 mg/kg followed by S-ketamine 0.25 mg kg-1 hr-1 infusionor placebo.

Main outcomes: Analgesicuse, pain (visual analogue scale 0-100 mm [VAS]) and labour market attachmentone year after surgery assessed by written questionnaires.

Results: Responserate was 67%. One year after surgery, the daily use of oral morphineequivalents was lower in the ketamine group versus the placebo group: 0 (0-20)mg versus 20 (0-62) mg, (p = 0.02), and fewer patients had a daily use of anyanalgesics in the ketamine group versus placebo group, 42% (95% CI 23-61)versus 74% (95% CI 58-87), (p = 0.04). Mobilization pain was lower in theketamine group compared to the placebo group: Median difference 17 mm (95% CI-30 to -3), (p = 0.02). Pain at rest was lower in the ketamine group comparedto the placebo group with median difference: 13 mm (95% CI -23 to -3), (p =0.01). Further, labour market attachment was better in the ketamine group, (p =0.02).

Conclusion: Intraoperativeketamine may reduce analgesic use, pain, and improve labour market attachmentone year after spine surgery in a chronic opioid-dependent population.

Significance: Thisrandomized clinical trial shows that intraoperative ketamine may reduce opioiduse and pain and improve labour market attachment one year after spine surgeryin an opioid-dependent population.

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