【罂粟摘要】美沙酮与吗啡对腹腔镜胃成形术患者术后恢复质量的影响：一项随机对照试验
美沙酮与吗啡对腹腔镜胃成形术患者术后恢复质量的影响：一项随机对照试验
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
本试验比较了术中静脉注射美沙酮与吗啡对腹腔镜胃成形术后恢复质量的影响。我们纳入了137名体重指数>35 kg·m-2并接受了减肥手术的成年患者。患者随机分为术中静注美沙酮组(69例)和吗啡组(68例)。所有患者均接受相同的术后护理和镇痛。术后24h用康复质量-40问卷总分评定术后恢复质量作为主要观察指标。次要观察指标为在麻醉后护理病房评估手术当天晚上(T1)、手术后早上(T2)和手术后第二天晚上(T3)对术后恢复质量的评定。美沙酮组恢复质量-40问卷总分中位数为194分，高于吗啡组的181分(174-185.5分)，差异有统计学意义(p<0.0001)。在麻醉后护理病房，美沙酮组的疼痛、恶心呕吐发生率、吗啡抢救剂量和出院时间均明显更低。在病房中，美沙酮组与吗啡组相比，在T1 (5.8vs.54.4%，p<0.0001)和T2(0vs.20.1%，p<0.0001)时，解救性吗啡需求剂量及恶心发生率(21.7vs.41.2%，p=0.014)均明显降低。我们得出结论，与术中吗啡相比，术中静脉注射美沙酮改善了腹腔镜胃成形术患者的康复质量。美沙酮还可以减少术后疼痛、术后阿片类药物消耗和阿片类药物相关不良事件的发生率。
Intra-operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial
Summary
The effect of intra-operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m-2 who underwent bariatric surgery. Patients were allocated at random to receive either intra-operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery-40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post-anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery-40 questionnaire score of 194 (190–197 [165– 200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174–185.5 [121–200]) in the morphine group. In the post-anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra-operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra-operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid-related adverse events.