Intraoperative Esmolol Infusion in the Absence of Opioids Spares Postoperative Fentanyl in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy
Intraoperative Esmolol Infusion in the Absence of Opioids Spares Postoperative Fentanyl in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy
复制标题
在不使用阿片类药物的情况下，术中输注艾司洛尔可替代接受门诊腹腔镜胆囊切除术的患者术后芬太尼
作者：
Vincent Collard;G. Mistraletti;A. Taqi;J. Asenjo;L. Feldman;G. Fried;F. Carli
背景：在门诊手术中使用阿片类药物可能会延误出院或导致意外入院。使用艾司洛尔替代阿片类药物的术中持续输注的初步研究报告了术后阿片类药物的节制效果。在这项研究中，我们比较了艾司洛尔与间歇芬太尼或持续瑞芬太尼在术后阿片类药物节省、副作用和出院时间方面的差异。方法：90例患者(由三组组成)参加了这项前瞻性、随机、观察者盲法研究。对照组(n=30)给予间歇量芬太尼，艾司洛尔组(n=30)术中持续输注艾司洛尔(5~15 mg·kg-1·−·−1)，术中不补充阿片类药物；瑞芬太尼组(n=30)持续静脉滴注瑞芬太尼(0.1~0.5 mg·kg−·min−1)。全身麻醉是标准化的，辅助药物包括扑热息痛、酮咯酸、皮肤切口处的局部麻醉剂、地塞米松和氟哌利多。术后镇痛包括芬太尼。结果：艾司洛尔组麻醉后监护病房芬太尼用量为91.50±42.7mg.g，明显少于瑞芬太尼237.8±54.7mg.g和对照组168.1±96.8mgr；g(P<；0.0001)。恶心发生率在对照组(66.7%)和瑞芬太尼(67.9%)组高于艾司洛尔组(30%)(P<；0.01)。艾司洛尔组达到White-Song评分(12分)较瑞芬太尼组快(P<0.01)，出院时间提前45~60min(P<；0.004)。结论：术中静脉输注艾司洛尔可显著减少术后芬太尼和恩丹西酮的用量，促进术后早期出院。
BACKGROUND:The use of opioids during ambulatory surgery can delay hospital discharge or cause unexpected hospital admission. Preliminary studies using an intraoperative continuous infusion of esmolol in place of an opioid have inconsistently reported a postoperative opioid-sparing effect. In this study, we compared esmolol versus either intermittent fentanyl or continuous remifentanil on postoperative opioid-sparing, side effects, and time of discharge. METHODS:Ninety patients (consisting of three groups) were enrolled in this prospective, randomized, and observer-blinded study. The control group (n = 30) received intermittent doses of fentanyl, the esmolol group (n = 30) received a continuous infusion of esmolol (5–15 &mgr;g · kg−1 · min−1) and no supplemental opioids during surgery, and the remifentanil group (n = 30) received a continuous infusion of remifentanil (0.1–0.5 &mgr;g · kg−1 · min−1). General anesthesia was standardized, and adjuvant medications included acetaminophen, ketorolac, local anesthetics in the skin incisions, dexamethasone, and droperidol. Postoperative analgesia included fentanyl. RESULTS:The amount of fentanyl in the postanesthesia care unit was significantly less in the esmolol group, 91.5 ± 42.7 &mgr;g, compared with the other two groups, remifentanil, 237.8 ± 54.7 &mgr;g, control, 168.1 ± 96.8 &mgr;g (P < 0.0001). The incidence of nausea was more frequent in the control (66.7%) and remifentanil (67.9%) groups compared with the esmolol group (30%) (P < 0.01). The esmolol group reached the White-Song score of 12 of 14 faster than the remifentanil group (P < 0.01), and left the hospital 45–60 min earlier (P < 0.004). CONCLUSIONS:Intraoperative IV infusion of esmolol contributes to a significant decrease in postoperative administration of fentanyl and ondansetron and facilitates earlier discharge.