[罂粟摘要]ERAS方案下无阿片类药物全麻在妇科腹腔镜手术中的应用：一项非劣效性随机对照试验

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ERAS方案下无阿片类药物全麻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

翻译:  柏雪

编辑:  严旭

审校: 曹莹

背景：

加速康复外科（enhanced recovery after surgery，ERAS）目前广泛应用于包括妇科腹腔镜手术在内的各个外科领域，但ERAS方案下妇科腹腔镜手术中无阿片类药物麻醉（OFA）的优势并不明确。

目的：

本研究旨在评估 OFA 方式与传统阿片类药物麻醉 (OA) 方式在 ERAS 下妇科腹腔镜手术中的有效性和可行性。

方法：

18～65岁接受妇科腹腔镜手术的成年女性患者随机分为使用艾氯胺酮和右美托咪定的OFA组(n = 39)和使用舒芬太尼和瑞芬太尼的OA组(n = 38)。所有患者均采用 ERAS 方案。主要结果是术后视觉模拟量表 (VAS) 评分(AUCVAS)的曲线下面积 (AUC)。次要结果包括术中血流动力学变量、苏醒和定向恢复时间、术后镇痛次数、术后恶心呕吐发生率(PONV)和围术期匹兹堡睡眠质量指数(PSQI)。

结果：

AUCVAS为（OFA 组，16.72 ± 2.50）vs（OA 组，15.99 ± 2.72）（p = 0.223）。两组患者术后所需的镇痛次数比较，差异无统计学意义 (p = 0.352)。手术切开即刻两组的平均动脉压（MAP）差异有统计学意义[（OFA 组，84.38 ± 11.08）vs（OA组, 79.00 ± 8.92), p = 0.022]。其余时段两组MAP和心率 (HR) 差异无统计学意义（分别为 p= 0.211 和 0.659）。OFA 组苏醒时间和定向力恢复时间（分别为 14.54 ± 4.22 和 20.69 ± 4.92）均长于 OA 组（12.63 ± 3.59 和 18.45 ± 4.08，分别）（p= 0.036 和 0.033）。OFA 组的 PONV 发生率 (10.1%) 显著低于 OA 组 (28.9%) (p= 0.027)。OFA组术后 PSQI 低于术前 (p= 0.013)。

结论：

在ERAS方案下的妇科腹腔镜手术中，OFA方式在镇痛效果和术中麻醉稳定性方面不劣于OA方式。尽管与OA相比苏醒和定向恢复时间延长，但OFA的PONV发生率较低，并改善了术后睡眠质量。

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. BMC Anesthesiology[J] (2023) 23:34, DOI: 10.1186/s12871-023-01994-5

英文原文：

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

Abstract 

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 (AUC VAS) 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 AUC VAS was (Group OFA, 16.72 ± 2.50) vs (Group OA, 15.99 ± 2.72) (p = 0.223). No difference 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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