阿片类与非阿片类麻醉的术后恢复差异

以下文章来源于小麻哥的日常 ，作者两只小绵羊

本文由“小麻哥的日常”授权转载

摘要译文（供参考） 乳腺癌手术后的恢复： 一项阿片类与胸椎旁阻滞非阿片类麻醉的随机对照试验

背景：阿片类药物的围手术期使用显示出与不良术后结果相关的显著不良反应。

目的：探讨以胸椎旁阻滞（thoracic paravertebral block，TPVB）为基础的无阿片类药物麻醉是否能促进癌症手术后的恢复。

设计：一项随机对照试验。

实施：三级教学医院。

患者：80名接受癌症手术的成年女性入选。关键的排除标准包括远处转移（但不包括手术侧腋窝淋巴结）、干预或药物禁忌症以及慢性疼痛或慢性阿片类药物使用史。

干预措施：符合条件的患者以1:1的比例随机接受基于TPVB的无阿片类药物麻醉（OFA组）或基于阿片类物质的麻醉（对照组）。

主要结局指标：主要结果是术后24小时15项恢复质量（15-item Quality of Recovery，QoR-15）问卷的总体得分。 次要结果包括术后疼痛和健康相关的生活质量。

结果：OFA组的QoR-15总体评分为140.3±5.2，对照组为132.0±12.0（P＜0.001）。 恢复良好（QoR-15整体评分≥118）的患者百分比在OFA组为100%（40/40），在对照组为82.5%（33/40）（P＝0.012）。 在敏感性分析中，OFA组生活质量的改善也很明显，将生活质量评为优秀，得分为136至150，在122至135时表现良好，在90至121时表现中等，在0至89时表现较差。 OFA组在身体舒适度（45.7±3.0对41.8±5.7，P<0.001）和身体独立性（18.3±2.2对16.3±4.5，P=0.014）方面得分较高。 两组在疼痛结果或健康相关生活质量方面没有差异。

结论：基于TPVB-无阿片类药物麻醉在不影响癌症手术患者疼痛控制的情况下提高了术后早期恢复质量。

Postoperative recovery after breast cancer surgery:  A randomised controlled trial of opioid-based versus opioid-free anaesthesia with thoracic paravertebral block

Abstract  

Background: Perioperative use of opioids has revealed significant adverse effects associated with poor postoperative outcomes. 

Objective: To determine whether opioid-free anaesthesia based on thoracic paravertebral block (TPVB) could improve postoperative recovery after breast cancer surgery. 

Design:A randomised controlled trial.

Setting:A tertiary teaching hospital. 

Patients: Eighty adult women undergoing breast cancer surgery were enrolled. Key exclusion criteria included remote metastasis (but not to axillary lymph nodes of the surgical side), contraindication to interventions or drugs and a history of chronic pain or chronic opioid use.

Interventions: Eligible patients were randomised at a 1 : 1 ratio to receive either TPVB-based opioid-free anaesthesia (OFA group) or opioid-based anaesthesia (control group). 

Main outcome measures: The primary outcome was the global score of the 15-item Quality of Recovery (QoR-15) questionnaire at 24 h after surgery. Secondary outcomes included postoperative pain and health-related quality of life.

Results: The QoR-15 global score was 140.3 ± 5.2 in the OFA group and 132.0 ± 12.0 in the control group ( P < 0.001). The percentage of patients with good recovery (QoR-15 global score ≥118) was 100% (40/40) in the OFA group and 82.5% (33/40) in the control group ( P = 0.012). Improved QoR in the OFA group was also evident in sensitivity analysis that rated QoR as excellent for a score of 136 to 150, as good at 122 to 135, as moderate at 90 to 121 and as poor at 0 to 89. The OFA group had higher scores in the domains of physical comfort (45.7 ± 3.0 versus 41.8 ± 5.7, P < 0.001) and physical independence (18.3 ± 2.2 versus 16.3 ± 4.5, P = 0.014). The two groups did not differ in pain outcomes or health-related quality of life. Conclusion: TPVB-based opioid-free anaesthesia improved early postoperative quality of recovery without compromising pain control in patients undergoing breast cancer surgery.

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。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：Michel.米萱

校对：MiLu.米鹭

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