ERAS方案下无阿片类药物全身麻醉在妇科腹腔镜手术中的应用：一项非劣效性随机对照试验

以下文章来源于罂粟花，作者anesthGH

本文由”罂粟花“授权转载

ERAS方案下无阿片类药物全身麻醉在妇科腹腔镜手术中的应用：一项非劣效性随机对照试验

贵州医科大学 麻醉与心脏电生理课题组

翻译：邓举

编辑：宋雨婷

审校：曹莹

背景：

加快术后康复（ERAS）目前广泛应用于包括妇科腹腔镜手术在内的各种手术领域，但ERAS方案下无阿片类药物麻醉（OFA）在妇科腹腔镜手术中的优势并不明确。

目的：

本研究旨在评估OFA技术与传统阿片类药物麻醉（OA）技术在ERAS理念下的妇科腹腔镜手术中的有效性和可行性。

方法：

将18岁~65岁拟行妇科腹腔镜手术的成年女性患者随机分为OFA组（n=39，使用艾司氯胺酮和右美托咪定）和OA组（n=38，使用舒芬太尼和瑞芬太尼）。所有患者均采用ERAS方案。主要指标是术后视觉模拟量表（VAS）评分的曲线下面积（AUC）（AUCVAS）。次要指标包括术中血流动力学的情况、苏醒和定向力恢复时间、术后补救镇痛次数、术后恶心呕吐（PONV）发生率和匹兹堡睡眠质量指数（PSQI）。

结果：

AUCVAS分别为（OFA组，16.72±2.50）和（OA组，15.99±2.72）（P =0.223）。在术后补救性镇痛（P =0.352）方面无显著差异。除开始进行手术切口时的MAP外[（OFA组，84.38±11.08)比(OA组，79.00±8.92），P =0.022]，组间平均动脉压（MAP）和心率（P =0.211和P =0.659）无差异。OFA组的觉醒时间和定向力恢复时间（14.54±4.22和20.69±4.92）均长于OA组（12.63±3.59和18.45±4.08）（P =0.036和P =0.033）。OFA组PONV的发生率（10.1%）明显低于OA组（28.9%）（P =0.027）。OFA组患者术后PSQI值低于术前（P =0.013）。

结论：

在ERAS方案下的妇科腹腔镜手术中，OFA的镇痛效果和术中麻醉稳定性均不逊于OA。虽然与OA相比，OFA的苏醒和定向恢复时间延长，但PONV发生率较低，术后睡眠质量有所改善。

原始文献来源：

Liang Chen, Wensheng He, Xue Liu,et al.Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial［J］.BMC Anesthesiology (2023) 23:34.

英文原文

Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial

Background: Enhanced recovery after surgery (ERAS) is now widely used in various surgical fields including gynecological laparoscopic surgery, but the advantages of opioid-free anesthesia (OFA) in gynecological laparoscopic surgery under ERAS protocol are inexact.

Aims: This study aims to assess the effectiveness and feasibility of OFA technique versus traditional opioid-based anesthesia (OA) technique in gynecological laparoscopic surgery under ERAS.

Methods: Adult female patients aged 18~65 years old undergoing gynecological laparoscopic surgery were randomly divided into OFA group (Group OFA, n=39) with esketamine and dexmedetomidine or OA group (Group OA, n=38) with sufentanil and remifentanil. All patients adopted ERAS protocol. The primary outcome was the area under the curve (AUC) of Visual Analogue Scale (VAS) scores (AUCVAS) postoperatively.Secondary outcomes included intraoperative hemodynamic variables, awakening and orientation recovery times, number of postoperative rescue analgesia required, incidence of postoperative nausea and vomiting (PONV) and Pittsburgh Sleep Quality Index (PSQI) perioperatively.

Results: AUCVAS was (Group OFA, 16.72±2.50) vs (Group OA, 15.99±2.72) (p=0.223). No diference was found in the number of rescue analgesia required (p=0.352). There were no between-group differences in mean arterial pressure (MAP) and heart rate (HR) (p=0.211 and 0.659, respectively) except MAP at time of surgical incision immediately [(Group OFA, 84.38±11.08) vs. (Group OA, 79.00±8.92), p=0.022]. Times of awakening and orientation recovery in group OFA (14.54±4.22 and 20.69±4.92, respectively) were both longer than which in group OA (12.63±3.59 and 18.45±4.08, respectively) (p=0.036 and 0.033, respectively). The incidence of PONV in group OFA (10.1%) was lower than that in group OA (28.9%) significantly (p=0.027). The postoperative PSQI was lower than the preoperative one in group OFA (p=0.013).

Conclusion: In gynecological laparoscopic surgery under ERAS protocol, OFA technique is non-inferior to OA technique in analgesic effect and intraoperative anesthesia stability. Although awakening and orientation recovery times were prolonged compared to OA, OFA had lower incidence of PONV and improved postoperative sleep quality.

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编辑：Michel.米萱

校对：MiLu.米鹭

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