脊麻下使用右美托咪定与异丙酚镇静对全膝关节置换术患者术后疼痛的比较：随机对照试验
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Comparison of Intraoperative Sedation With
Dexmedetomidine Versus Propofol on Acute
Postoperative Pain in Total Knee Arthroplasty
Under Spinal Anesthesia: A Randomized Trial
背景与目的
在脊麻下进行全膝关节置换术的患者中，我们比较术中使用右美托咪定与异丙酚镇静的对术后镇痛效果的影响。 我们假设使用右美托咪定镇静的患者术后阿片类镇痛药物的消耗量较少。
方 法
将48名患者入选并随机分配到右美托咪定组（n = 24）或丙泊酚组（n = 24），右美托咪定组在10分钟内接受1μg/ kg右美托咪定负荷剂量，然后连续输注0.1-0.5μg·kg·小时，丙泊酚组通过靶控输注持续输注丙泊酚，保持效应浓度在0.5-2.0μg/ mL范围内。药物注射速率是根据镇静水平确定的，目标是一个合适的观察者评估镇静评分到3-4分。在术后24和48小时记录通过静脉内自控镇痛施用的芬太尼累积量（主要结果）。在6,12,24和48小时评估疼痛的术后数字评估量表（次要结果）。还比较了24小时和48小时两组之间术后使用额外镇痛药（酮洛芬）和止吐药。
结 果
右美托咪定在0-24小时，24-48小时期间显着降低术后芬太尼消耗。与丙泊酚组相比，右美托咪定组手术后12小时，24小时和48小时的数值评定量表评分更低。 在手术后24小时和48小时，在其他止痛剂和止吐药的量上没有观察到显着的组间差异。
结 论
右美托咪定镇静的全膝关节置换术患者术后使用阿片类药物的量减小。
原始文献摘要
Mei B, Meng G, Xu G, et al. Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty: A Prospective Randomized Controlled Study.[J]. Clinical Journal of Pain, 2018:1.
BACKGROUND:
In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol.
METHODS:
Forty-eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0.1-0.5 μg·kg·hour, or a propofol group (n = 24), which received a continuous infusion of propofol via a target-controlled infusion to maintain the effect-site concentration within a range of 0.5-2.0 μg/mL. The drug infusion rate was determined according to the sedation level, targeting a modified observer's assessment of alertness/sedation score of 3 or 4. The cumulative amounts of fentanyl administered via intravenous patient-controlled analgesia were recorded at 24 and 48 hours postoperatively (primary outcome). The postoperative numerical rating scale for pain was assessed at 6, 12, 24, and 48 hours (secondary outcome). The postoperative use of additional rescue analgesic (ketoprofen) and antiemetic drugs was also compared between the 2 groups at 24 and 48 hours.
RESULTS:
Dexmedetomidine significantly reduced postoperative fentanyl consumption (median [interquartile range]) during 0-24 hours (45 [30-71] vs 150 [49-248] μg, P = .004; median difference = -105 μg [99.98% CI, 210-7.5]), 24-48 hours (90 [45-143] vs 188 [75-266] μg, P = .005; median difference = -98 μg [99.98% CI, 195-45]), and 0-48 hours (135 [68-195] vs 360 [146-480] μg, P = .003; median difference = -225 μg [99.98% CI, 405-7.5]). The numerical rating scale (median [interquartile range]) was lower at 6 hours (1 [0-2] vs 2 [1-3], P = .003), 12 hours (1 [1-2] vs 3 [2-3], P < .001), 24 hours (1 [1-2] vs 3 [2-3], P < .001), and 48 hours (2 [2-3] vs 3 [3-4], P < .001) after surgery in the dexmedetomidine group compared to the propofol group. No significant intergroup differences were observed in the amount of rescue analgesics and antiemetics at 24 hours (P = .155 and P = .482) and 48 hours (P = .082 and P = .153) after surgery.
CONCLUSIONS:
Intraoperative dexmedetomidine sedation was associated with a small but clinically important reduction in postoperative opioid use after total knee arthroplasty.
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