围手术期应用普瑞巴林和艾司氯胺酮预防乳腺癌手术后慢性疼痛：一项随机对照试验

以下文章来源于罂粟花 ，作者anesthGH

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围手术期应用普瑞巴林和艾司氯胺酮预防乳腺癌手术后慢性疼痛：一项随机对照试验

贵州医科大学    麻醉与心脏电生理课题组

翻译：马艳燕

编辑：宋雨婷

审校：曹莹

背景：

围手术期多模式镇痛可预防乳腺癌术后慢性疼痛。本研究旨在探讨围手术期口服普瑞巴林和术后使用艾司氯胺酮联合应用预防乳腺癌术后慢性疼痛的疗效。

方法：

90例择期乳腺癌手术患者被随机分为普瑞巴林复合艾司氯胺组(EP组)和单纯全麻组(对照组)。EP组在术前1小时口服普瑞巴林150mg，术后7天每天口服两次，术后使用PCIA(100μg舒芬太尼+ 1.25mg/kg艾氯胺酮+ 4mg托烷司琼+ 100mL生理盐水)镇痛。对照组在手术前后给予安慰剂胶囊和术后常规镇痛（100μg舒芬太尼+ 4mg托烷司琼+ 100mL生理盐水）。主要指标是术后3个月和6个月慢性疼痛的发生率。次要指标包括术后急性疼痛，阿片类药物消耗量和不良事件发生率。

结果：

EP组术后3个月(14.3%比46.3%，P =0.005)和6个月(7.1%比31.7%，P =0.009)慢性疼痛发生率明显低于对照组。EP组术后1-3天静息疼痛数字评价表(NRS)评分和术后1-7天咳嗽时NRS评分均明显低于对照组(P ˂0.05)。

结论：

围手术期口服普瑞巴林与术后使用艾氯胺酮联合治疗可有效预防乳腺癌术后慢性疼痛，改善术后急性疼痛，减少术后阿片类药物使用。

原始文献来源：

Wang M, Xiong HP, Sheng K, Sun XB, Zhao XQ, Liu QR. Perioperative Administration of Pregabalin and Esketamine to Prevent Chronic Pain After Breast Cancer Surgery: A Randomized Controlled Trial. Drug Des Devel Ther. 2023 Jun 8;17:1699-1706. 

英文原文

Perioperative Administration of Pregabalin and Esketamine to Prevent Chronic Pain After Breast Cancer Surgery: A Randomized Controlled Trial  

Background: Perioperative multimodal analgesia can prevent chronic pain after breast cancer surgery. This study aimed to investigate the efficacy of combined perioperative oral pregabalin and postoperative esketamine in preventing chronic pain after breast cancer surgery.

Methods: Ninety patients undergoing elective breast cancer surgery were randomized into the combined pregabalin and esketamine group (EP group) and the general anesthesia alone group (Control group). The EP group received 150 mg of oral pregabalin 1 h before surgery and twice daily for seven days postoperatively, and a patient-controlled analgesia pump after surgery that delivered 100 μg sufentanil + 1.25 mg/kg esketamine + 4 mg tropisetron in 100 mL saline solution intravenously. The Control group received placebo capsules before and after the surgery and routine postoperative analgesia (100 μg sufentanil + 4 mg tropisetron in 100 mL saline solution). The primary outcome was the incidence of chronic pain three and six months after surgery. Secondary outcomes included acute postoperative pain, postoperative opioid consumption, and incidence of adverse events.

Results: The incidence of chronic pain in the EP group was significantly lower than in the Control group three (14.3% vs 46.3%, P = 0.005) and six (7.1% vs 31.7%, P = 0.009) months postoperatively. The rest numerical rating scale (NRS) pain scores 1-3 days postoperatively and coughing NRS pain scores 1-7 days postoperatively in the EP group were significantly lower than in the Control group (all P ˂ 0.05). The cumulative sufentanil consumption in the EP group during postoperative 0-12, 12-24, and 24-48, 0-24, and 0-48 hours were significantly lower than in the Control group (all P ˂ 0.05).

Conclusion: Combined perioperative oral pregabalin and postoperative esketamine effectively prevented chronic pain after breast cancer surgery, improved acute postoperative pain, and reduced postoperative opioid consumption.

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编辑：MiLu.米鹭

校对：Michel.米萱  

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