Preoperative But Not Postoperative Flurbiprofen Axetil Alleviates Remifentanil-induced Hyperalgesia After Laparoscopic Gynecological Surgery: A Prospective, Randomized, Double-blinded, Trial
Preoperative But Not Postoperative Flurbiprofen Axetil Alleviates Remifentanil-induced Hyperalgesia After Laparoscopic Gynecological Surgery: A Prospective, Randomized, Double-blinded, Trial
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术前而非术后氟比洛芬酯可减轻腹腔镜妇科手术后瑞芬太尼引起的痛觉过敏：一项前瞻性、随机、双盲试验
DOI：
10.1097/ajp.0000000000000416
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发表时间：
2017-05-01
影响因子：
2.9
通讯作者：
Wang, Guolin
中科院分区：
文献类型：
--
作者：
Zhang, Linlin;Shu, Ruichen;Wang, Guolin
背景资料：术中镇痛时瑞芬太尼急性暴露可能会增加对伤害性刺激的敏感性和对无害刺激的伤害性反应。在啮齿动物和人类志愿者中，环氧合酶抑制剂被证明可以减轻实验性瑞芬太尼诱导的痛觉过敏（RIH）。该研究旨在比较术前和术后氟比洛芬酯（FA）对术后RIH的影响。材料与方法：90例择期腹腔镜妇科手术患者随机分为麻醉诱导前静脉注射安慰剂组（C组），麻醉诱导前静脉注射FA（1.0 mg/kg）组（F1组）或皮肤缝合前静脉注射FA（1.0 mg/kg）组（F2组）。麻醉由七氟烷和瑞芬太尼（0.30 g/kg/min）组成。在麻醉后监护室通过舒芬太尼滴定管理术后疼痛，然后通过患者自控镇痛输注舒芬太尼。术后24小时记录机械疼痛阈值（主要结局）、疼痛评分、舒芬太尼用量和副作用。结果：F1组术后疼痛评分低于C组。F1组术后首次舒芬太尼滴定时间较C组延长（P=0.021）。F1组的舒芬太尼累积消耗量低于C组（P<0.001），平均差异为8.75（95%置信区间，5.21-12.29）g。F1组中优势前臂内侧的机械痛阈比C组更高（P=0.005），平均差异为17.7（95%置信区间，5.4-30.0）g。与C组相比，F1组的标准化痛觉过敏面积减少（P=0.007）。F2组与C组之间未观察到统计学显著差异。结论：术前FA可减少在七氟烷-瑞芬太尼麻醉下接受腹腔镜妇科手术的患者术后RIH。
Background: Acute remifentanil exposure during intraoperative analgesia might enhance sensitivity to noxious stimuli and nociceptive responses to innocuous irritation. Cyclooxygenase inhibition was demonstrated to attenuate experimental remifentanil-induced hyperalgesia (RIH) in rodents and human volunteers. The study aimed to compare the effects of preoperative and postoperative flurbiprofen axetil (FA) on RIH after surgery. Materials and Methods: Ninety patients undergoing elective laparoscopic gynecologic surgery were randomly assigned to receive either intravenous placebo before anesthesia induction (Group C); or intravenous FA (1.0 mg/kg) before anesthesia induction (Group F1) or before skin closure (Group F2). Anesthesia consisted off sevoflurane and remifentanil (0.30 &mgr;g/kg/min). Postoperative pain was managed by sufentanil titration in the postanesthetic care unit, followed by sufentanil infusion via patient-controlled analgesia. Mechanical pain threshold (primary outcome), pain scores, sufentanil consumption, and side-effects were documented for 24 hours postoperatively. Results: Postoperative pain score in Group F1 was lower than Group C. Time of first postoperative sufentanil titration was prolonged in Group F1 than Group C (P=0.021). Cumulative sufentanil consumption in Group F1 was lower than Group C (P<0.001), with a mean difference of 8.75 (95% confidence interval, 5.21-12.29) &mgr;g. Mechanical pain threshold on the dominant inner forearm was more elevated in Group F1 than Group C (P=0.005), with a mean difference of 17.7 (95% confidence interval, 5.4-30.0) g. Normalized hyperalgesia area was decreased in Group F1 compared to Group C (P=0.007). No statistically significant difference was observed between Group F2 and Group C. Conclusions: Preoperative FA reduces postoperative RIH in patients undergoing laparoscopic gynecologic surgery under sevoflurane-remifentanil anesthesia.