目的: 评价无阿片类药物麻醉在老年腹部外科手术中的可行性和应用效果。方法: 选取2021年6月至2022年12月本院104例65~85岁接受过腹部外科手术的患者,随机分为无阿片类药物麻醉(opioid-free anesthesia,OFA)组(右美托咪定、利多卡因联合硬膜外镇痛方案)和阿片类药物麻醉(opioid anesthesia,OA)组(舒芬太尼、瑞芬太尼联合硬膜外镇痛方案),每组各52例。观察主要指标:术后24 h内视觉模拟评分(visual analogue scale,VAS),术中、术后硬膜外镇痛药物消耗量;次要指标:术中不同时刻平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR),术中麻醉效果,术后24 h内不良反应发生情况。结果: 与OA组相比,OFA组在术后8 h后VAS评分降低(P＜0.001);两组术中硬膜外混合药物消耗量比较差异无统计学意义(P＞0.05);OFA组术后24 h硬膜外罗哌卡因累积消耗量低于OA组(P＜0.001);两组间不同时刻MAP、HR比较差异无统计学意义(P＞0.05);两组术中麻醉效果比较差异无统计学意义(P＞0.05);两组术后苏醒时间、拔管时间,OFA组短于OA组(P＜0.05);OFA组术后24 h内恶心、呕吐发生率及严重程度低于OA组(P＜0.05)。结论: 对于老年腹部外科手术,无阿片类药物麻醉方案是可行的。与阿片类药物麻醉方案相比,术中麻醉效果相同,但该方案可以缩短术后苏醒时间,降低术后24 h内疼痛程度、恶心和呕吐发生率及严重程度。
Objective: To evaluate the feasibility and application effect of opioid-free anesthesia in elderly abdominal surgery. Methods: A total of 104 patients aged 65 to 85 years with abdominal surgery were enrolled. They were randomized into the OFA group (dexmedetomidine and lidocaine plus epidural analgesia) and OA group (sufentanil, refentanil plus epidural analgesia), with 52 cases in each group. The main indicators including visual analogue scale (VAS) within 24 hours after surgery, intraoperative and postoperative epidural analgesic drug consumption were observed. Secondary indicators such as mean arterial pressure (MAP), heart rate (HR) at different moments during surgery, intraoperative anesthesia effect, occurrence of adverse reactions within 24 hours after surgery were also recorded. Results: Compared with the OA group, the VAS score in the OFA group decreased after 8 hours after surgery (P＜0.001), and there was no significant difference in intraoperative epidural drug consumption between the two groups (P＞0.05). The cumulative epidural consumption of ropivacaine 24 hours after surgery in the OFA group was lower than that in the OA group (P＜0.001), and there was no significant difference in MAP and HR at different timepoints between the two groups (P＞0.05). There was no significant difference in the effect of intraoperative anesthesia between the two groups (P＞0.05). The postoperative recovery time and extubation time of the two groups were shorter than those in the OA group (P＜0.05). The incidence and severity of nausea and vomiting in the OFA group within 24 h after surgery were lower than those in the OA group (P＜0.05). Conclusion: For elderly abdominal surgery, the opioid-free anesthesia regimen provided in this study is feasible. Compared with opioid anesthesia regimen, intraoperative anesthesia has the same effect but shorter postoperative recovery time, which can also lower the severity of pain and reduce the incidence of nausea and vomiting within 24 h after surgery.
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