Postoperative left prefrontal repetitive transcranial magnetic stimulation reduces patient-controlled analgesia use
Postoperative left prefrontal repetitive transcranial magnetic stimulation reduces patient-controlled analgesia use
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DOI：
10.1097/00000542-200609000-00020
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发表时间：
2006-09-01
期刊：
影响因子：
8.8
通讯作者：
George, Mark S.
中科院分区：
文献类型：
--
作者：
Borckardt, Jeffrey J.;Weinstein, Mitchel;George, Mark S.
背景：最近的几项研究表明，使用实验室疼痛模型，重复经颅磁刺激可以暂时减少神经性疼痛患者和健康成年人的疼痛感知。尚无研究探讨经颅磁刺激的前额皮质刺激对术后疼痛的影响。方法：20 名胃绕道手术患者被随机分配在手术后立即接受 20 分钟的主动或假左前额叶重复经颅磁刺激。跟踪患者自控镇痛泵的使用情况，患者还使用视觉模拟量表每天两次对疼痛和情绪进行评分。结果：各组在基线时的体重指数、年龄、情绪评分、疼痛评分、手术持续时间、麻醉时间和手术麻醉方法方面相似。观察到手术类型（开放与腹腔镜）和条件（主动与假经颅磁刺激）对手术后 44 小时内患者输送吗啡累积量的显着影响。术后 44 小时内，与假手术相比，主动前额叶重复经颅磁刺激可使吗啡使用总量减少 40%。这种效果似乎在皮质刺激后的前 24 小时内最为突出。没有观察到重复经颅磁刺激对情绪评级的影响。结论：单次术后前额叶重复经颅磁刺激与胃绕道手术患者自控镇痛泵使用量的减少相关。这一点很重要，因为术后使用吗啡的风险很高，尤其是经常患有阻塞性睡眠呼吸暂停、右心室功能障碍和肺动脉高压的肥胖患者。这些初步研究结果提出了一种潜在的新的非侵入性方法来管理术后吗啡的使用。
Background: Several recent studies suggest that repetitive transcranial magnetic stimulation can temporarily reduce pain perception in neuropathic pain patients and in healthy adults using laboratory pain models. No studies have investigated the effects of prefrontal cortex stimulation using transcranial magnetic stimulation on postoperative pain.Methods: Twenty gastric bypass surgery patients were randomly assigned to receive 20 min of either active or sham left prefrontal repetitive transcranial magnetic stimulation immediately after surgery. Patient-controlled analgesia pump use was tracked, and patients also rated pain and mood twice per day using visual analog scales.Results: Groups were similar at baseline in terms of body mass index, age, mood ratings, pain ratings, surgery duration, time under anesthesia, and surgical anesthesia methods. Significant effects were observed for surgery type (open vs. laparoscopic) and condition (active vs. sham transcranial magnetic stimulation) on the cumulative amount of patient-delivered morphine during the 44 h after surgery. Active prefrontal repetitive transcranial magnetic stimulation was associated with a 40% reduction in total morphine use compared with sham during the 44 h after surgery. The effect seemed to be most prominent during the first 24 h after cortical stimulation delivery. No effects were observed for repetitive transcranial magnetic stimulation on mood ratings.Conclusions: A single session of postoperative prefrontal repetitive transcranial magnetic stimulation was associated with a reduction in patient-controlled analgesia pump use in gastric bypass surgery patients. This is important because the risks associated with postoperative morphine use are high, especially among obese patients who frequently have obstructive sleep apnea, right ventricular dysfunction, and pulmonary hypertension. These preliminary findings suggest a potential new noninvasive method for managing postoperative morphine use.