Anesthesiology:围手术期使用普瑞巴林和氯胺酮可预防心脏手术后的持续性疼痛

2020-06-29 MedSci原创 MedSci原创

手术后的持续性疼痛十分常见,影响患者的生活质量。本研究假设使用前加巴林和氯胺酮可以预防心脏手术后的持续性疼痛。

手术后的持续性疼痛十分常见,影响患者的生活质量。本研究假设使用前加巴林和氯胺酮可以预防心脏手术后的持续性疼痛。

 

这项随机、双盲、安慰剂对照试验在英国的两个心脏手术中心进行。将没有慢性疼痛的成人和经胸骨切开术接受任何选择性心脏手术的患者随机分配到接受通常的护理,单独使用预加巴林(术前150 mg,术后14天每天两次),或预加巴林与术后48 h静脉输注氯胺酮联合使用,剂量为0. 1 mg· kg· h.主要终点为术后3个月和6个月临床显著疼痛的发生率,定义为3次最大咳嗽功能评估后,数值评分表上的疼痛评分为4分或更高(满分10分)。次要结果包括急性疼痛、阿片类药物使用和安全措施,以及长期神经病理性疼痛、镇痛需求和生活质量。

 

结果,共有150名患者被随机化,17名患者退出治疗,2名患者失访,但对所有参与者的数据进行了意向治疗分析。与对照组(34%[50人中的17人];OR=0.126[0.022~0.5],P=0.0008;和0.041[0.0009~0. 28],P <0.0001)相比,术后3个月时,单独使用普瑞巴林(6%[50人中的3人])和与氯胺酮联合使用(2%[50人中的1人])组患者疼痛发生率较低;在6个月时,与对照组(28%[50人中的14人];OR=0.167[0.029~0.7],P = 0.006;和0.000[0~0.24],P <0.0001)相比,单用前加巴林(6%[50人中的3人])和与氯胺酮0%(5人中的0人)联用组患者疼痛发生率较低。

 

综上所述,该研究结果表明,术前服用150mg预加巴林,术后继续服用,每日两次,持续14天,可显著降低心脏手术后持续性疼痛的发生率。

 

原始出处:

 

Sibtain AnwarJackie Cooper, et al., Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain After Cardiac Surgery. Anesthesiology. 2019 Jul;131(1):119-131.

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    2020-07-01 jml2009
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    2020-07-01 skhzy

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