无阿片类药物麻醉技术应用于开颅手术

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无阿片类药物麻醉技术应用于开颅手术

贵州医科大学麻醉与心脏电生理课题组

翻译 :  柏雪

编辑 :  严旭

审校 :  曹莹

背景:开颅手术在围手术期使用了阿片类药物会导致过度镇静和依赖面罩通气，这些将阻碍神经系统检查。目前包括神经阻滞在内的多模式无阿片类药物麻醉技术已在其他类手术中成功实践;然而，目前的文献中没有评估无阿片类药物麻醉应用于开颅手术的临床数据。

材料和方法:6例前瞻性确定的患者在埃默里大学医院接受了幕上开颅手术，采用多模式无阿片类药物麻醉(OFA)技术，包括术前头皮阻滞、右美托咪定和静脉注射对乙酰氨基酚。这些无阿片类药物患者按年龄、性别、切口长度和切口位置18名回顾性确定的对照患者相匹配，这18位对照患者使用常规阿片类药物麻醉技术进行开颅手术。比较术后阿片类药物消耗和疼痛评分，并分析其非劣效性。

结果：从麻醉恢复室到术后24小时的所有测量间隔，都证明了 OFA 技术在阿片类药物消耗方面的非劣效性。在 0 至 12 小时、0 至 24 小时的平均术后疼痛评分以及留在麻醉恢复室的时间方面也证明了非劣效性。术后阿片类药物完全代谢的时间、术后 12 至 24 小时的疼痛评分或从麻醉过程中突然苏醒的时间未显示非劣效性。  

结论：这项研究初步证明了 OFA 技术对接受幕上开颅手术的患者的可行性，并建议进行更大规模的前瞻性随机对照试验来检查多模式麻醉技术在开颅手术中的作用。   

原始文献来源 ：  

Ian L. McCullough , Jack W. Shteamer , Andrew M. Erwood , et, al. Opioid-Free Anesthesia for Craniotomy. J Neurosurg Anesthesiol 2023;35:80–85.

英文原文

Opioid-Free Anesthesia for Craniotomy

Background: Perioperative opioids are problematic following craniotomy as they can impede neurological examination because of excessive sedation and mask surgical complications.Multimodal anesthetic techniques including nerve blocks have been used successfully to deliver opioid-free anesthesia in other surgical populations; however, no clinical data evaluating opioid-free anesthesia for craniotomy exists within the current body of literature.

Materials and Methods: Six prospectively identified patients underwent supratentorial craniotomy at Emory University Hospital using a multimodal opioid-free anesthetic (OFA) technique consisting of preoperative scalp block, dexmedetomidine and intravenous acetaminophen. These opioid-free patients were matched by age, sex, incision length, and incision location to 18 retrospectively identified control patients who underwent craniotomy using conventional, opioid-based anesthetic techniques.Postoperative opioid consumption and pain scores were compared and analyzed for noninferiority.

Results: Noninferiority of the OFA technique was demonstrated for opioid consumption at all measured intervals from postanesthesia care unit arrival to 24 hours postoperatively. Noninferiority was also demonstrated with respect to average postoperative pain scores from 0 to 12 hours, 0 to 24 hours, as well as length of postanesthesia care unit stay. Noninferiority was not shown for time to first rescue opioid postoperatively, pain scores for the 12 to 24 hours postoperative period, or time to emergence from anesthesia.

Conclusions: This pilot study demonstrates the feasibility of an OFA technique for patients undergoing supratentorial craniotomy and suggests that larger prospective randomized controlled trials are indicated to examine the role of multimodal anesthetic techniques for craniotomy. 

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱  

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