羟考酮在腹腔镜全子宫切除术后镇痛中的应用
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摘要
目的观察羟考酮不同镇痛方案在腹腔镜全子宫切除术后自控静脉镇痛中的应用效果。方法选择择期全麻下行腹腔镜全子宫切除术患者75例,年龄40～65岁,BMI 18～24kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法均分为三组:吗啡组(M组)、羟考酮持续背景剂量组(O1组)和羟考酮无背景剂量组(O2组)。三组静脉注射芬太尼4μg/kg、丙泊酚2～2.5mg/kg、顺式阿曲库铵0.2mg/kg行麻醉诱导。M组术后镇痛泵药物为吗啡50mg+昂丹司琼8mg加生理盐水至100ml,背景剂量2ml/h,PCA剂量0.5ml,锁定时间5min;O1和O2组术后镇痛泵药物为羟考酮50mg+昂丹司琼8mg加生理盐水到100ml,O1组背景剂量2ml/h,PCA剂量0.5ml,锁定时间5min;O2组无背景剂量,PCA 4ml,锁定时间5min。记录术后4、8、12、24和48h的NRS评分;记录术后48h内补救镇痛次数、镇痛药用量和术后48h内不良反应发生情况。结果 O1、O2组术后4、8、12h静态NRS评分明显低于M组(P<0.05);O1、O2组术后4、8h动态NRS评分明显低于M组(P<0.05);M组术后48h内补救镇痛次数明显多于O1、O2组(P<0.05);O2组术后48h内镇痛药总用量及不良反应发生率明显低于M、O1组(P<0.05)。结论羟考酮较之吗啡在腹腔镜全子宫切除术后静脉镇痛中可以起到更好的镇痛效果并降低术后恶心呕吐的发生率。
Objective To observe the effect of oxycodone for postoperative patient-controlled intravenous analgesia of laparoscopic total hysterectomy with or without background infusion.Methods Seventy five patients,aged 40-65 years,BMI 18-24 kg/m2,ASA physical statusⅠ orⅡ,scheduled for elective laparoscopic total hysterectomy surgery under general anesthesia were randomly assigned into 3 equal groups(n = 25 each)using a random number table:morphine group(group M),oxycodone with background infusion group(group O1)and oxycodone without background infusion group(group O2).The anesthesia was induced by intravenous fentanyl 4μg/kg,propofol 2-2.5 mg/kg and cisatracurium 0.2 mg/kg.Group M was given morphine 50 mg+ondanstron 8 mg in100 ml normal saline,groups O1 and O2 were given oxycodone 50 mg+ ondanstron 8 mg in 100 ml normal saline.The PCIA pump of group M and group O1 were set up with a 0.5 ml bolus dose,a 5 min lockout interval and background infusion at a rate of 2 ml/h.Group O2 was set up with a 4 ml bolus dose,a 5 min lockout interval and without background infusion.The NRS scores of three groups at 4,8,12,24 and 48 hafter operation were recorded.The total morphine or oxycodone consumption,and the number of rescue analgesia within 48 hafter surgery were recorded.The adverse events within 48 hafter surgery were also observed.Results Compared with group M,the NRS scores at rest were significantly decreased at 4,8,and 12 hafter operation(P<0.05),and the NRS scores at movement were significantly decreased at 4 and 8 hafter operation(P<0.05),and the number of rescue analgesia within 48 hafter surgery was significantly decreased in groups O1 and O2(P<0.05).The total analgesic consumption and the incidence of adverse event within 48 hafter surgery in group O2 were significantly lower than those in groups M and O1(P<0.05).Conclusion Compared with morphine,oxycodone for patient-controlled intravenous analgesia can obtain more satisfactory effects after laparoscopic total hysterectomy surgery.Meanwhile,the total consumption of oxycodone and the incidence of nausea and vomiting are significantly decreased.
Objective To observe the effect of oxycodone for postoperative patient-controlled intravenous analgesia of laparoscopic total hysterectomy with or without background infusion.Methods Seventy five patients,aged 40-65 years,BMI 18-24 kg/m2,ASA physical statusⅠ orⅡ,scheduled for elective laparoscopic total hysterectomy surgery under general anesthesia were randomly assigned into 3 equal groups(n = 25 each)using a random number table:morphine group(group M),oxycodone with background infusion group(group O1)and oxycodone without background infusion group(group O2).The anesthesia was induced by intravenous fentanyl 4μg/kg,propofol 2-2.5 mg/kg and cisatracurium 0.2 mg/kg.Group M was given morphine 50 mg+ondanstron 8 mg in100 ml normal saline,groups O1 and O2 were given oxycodone 50 mg+ ondanstron 8 mg in 100 ml normal saline.The PCIA pump of group M and group O1 were set up with a 0.5 ml bolus dose,a 5 min lockout interval and background infusion at a rate of 2 ml/h.Group O2 was set up with a 4 ml bolus dose,a 5 min lockout interval and without background infusion.The NRS scores of three groups at 4,8,12,24 and 48 hafter operation were recorded.The total morphine or oxycodone consumption,and the number of rescue analgesia within 48 hafter surgery were recorded.The adverse events within 48 hafter surgery were also observed.Results Compared with group M,the NRS scores at rest were significantly decreased at 4,8,and 12 hafter operation(P<0.05),and the NRS scores at movement were significantly decreased at 4 and 8 hafter operation(P<0.05),and the number of rescue analgesia within 48 hafter surgery was significantly decreased in groups O1 and O2(P<0.05).The total analgesic consumption and the incidence of adverse event within 48 hafter surgery in group O2 were significantly lower than those in groups M and O1(P<0.05).Conclusion Compared with morphine,oxycodone for patient-controlled intravenous analgesia can obtain more satisfactory effects after laparoscopic total hysterectomy surgery.Meanwhile,the total consumption of oxycodone and the incidence of nausea and vomiting are significantly decreased.
引文
[1]Chou R,Gordon DB,de Leon-Casasola OA,et al.Management of postoperative pain:a clinical practice guideline from the American Pain Society,the American Society of Regional Anesthesia and Pain Medicine,and the American Society of AnesthesiologistsCommittee on Regional Anesthesia,executive committee,and administrative council.J Pain,2016,17(2):131-157.
[2]Guler T,Unlugenc H,Gundogan Z,et al.A background infusion of morphine enhances patient-controlled analgesia after cardiac surgery.Can J Anaesth,2004,51(7):718-722.
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[5]韩旭东,李怡林,张小兰,等.快速康复外科技术联合术后多模式镇痛对腹腔镜卵巢囊肿剥除术患者围术期康复的影响.中国医师杂志,2017,19(4):571-573.
[6]王淼,刘清仁,张云慧,等.羟考酮与地佐辛用于腹腔镜手术后镇痛效果的比较.临床麻醉学杂志,2018,34(2):183-184.
[7]Ding Z,Wang K,Wang B,et al.Efficacy and tolerability of oxycodone versus fentanyl for intravenous patient-controlled analgesia after gastrointestinal laparotomy:a prospective,randomized,double-blind study.Medicine(Baltimore),2016,95(39):e4943.
[8]Kim NS,Lee JS,Park SY,et al.Oxycodone versus fentanyl for intravenous patient-controlled analgesia after laparoscopic supracervical hysterectomy:a prospective,randomized,double-blind study.Medicine(Baltimore),2017,96(10):e6286.
[9]廖俊锋,屠文龙,杨娜,等.羟考酮递减法背景输注在胸腔镜肺叶切除患者术后镇痛中的临床效果观察.中国内镜杂志,2017,23(3):14-19.
[2]Guler T,Unlugenc H,Gundogan Z,et al.A background infusion of morphine enhances patient-controlled analgesia after cardiac surgery.Can J Anaesth,2004,51(7):718-722.
[3]George JA,Lin EE,Hanna MN,et al.The effect of intravenous opioid patient-controlled analgesia with and without background infusion on respiratory depression:a meta-analysis.J Opioid Manag,2010,6(1):47-54.
[4]Woolf CJ.Central sensitization:implications for the diagnosis and treatment of pain.Pain,2011,152(3 Suppl):S2-S15.
[5]韩旭东,李怡林,张小兰,等.快速康复外科技术联合术后多模式镇痛对腹腔镜卵巢囊肿剥除术患者围术期康复的影响.中国医师杂志,2017,19(4):571-573.
[6]王淼,刘清仁,张云慧,等.羟考酮与地佐辛用于腹腔镜手术后镇痛效果的比较.临床麻醉学杂志,2018,34(2):183-184.
[7]Ding Z,Wang K,Wang B,et al.Efficacy and tolerability of oxycodone versus fentanyl for intravenous patient-controlled analgesia after gastrointestinal laparotomy:a prospective,randomized,double-blind study.Medicine(Baltimore),2016,95(39):e4943.
[8]Kim NS,Lee JS,Park SY,et al.Oxycodone versus fentanyl for intravenous patient-controlled analgesia after laparoscopic supracervical hysterectomy:a prospective,randomized,double-blind study.Medicine(Baltimore),2017,96(10):e6286.
[9]廖俊锋,屠文龙,杨娜,等.羟考酮递减法背景输注在胸腔镜肺叶切除患者术后镇痛中的临床效果观察.中国内镜杂志,2017,23(3):14-19.