A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher\'s test. 95% C.I and P values < 0.05.
Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p < 0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54-5.37) vs. OP 6.39 (6.07-6.71) (p < 0.001). Methadone requirement was lower in the OFA-plus (p < 0.001). 78% of patients in OFA-plus didn\'t need methadone rescue. 95% in OP group needed methadone rescues at high doses(> 15 mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p < 0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown.
OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids\' use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.
回顾,设计了连续病例系列研究。42例接受CCF的EDS-HT/JHS患者分为两组:接受丙泊酚无阿片类药物麻醉的OFA-plus组,利多卡因,氯胺酮和右美托咪定,和OP组,基于阿片类药物的麻醉镇痛。主要变量:术前视觉模拟评分(VAS),术后VAS1号,2nd,第四天和第六天,舒芬太尼或吗啡的需求,需要美沙酮救援,和VAS在出院时。数据以平均值±SD表示,百分比,中位数或四分位数范围。卡方检验或费希尔检验。95%C.I和P值<0.05。
OFA-plus的19名患者,OP组23例。在评估的术后天数,OFA-plus的VAS较低(p<0.001)。OFA+出院时的VAS较低:4.96(4.54-5.37)。OP6.39(6.07-6.71)(p<0.001)。OFA+中的美沙酮需求较低(p<0.001)。78%的OFA-plus患者不需要美沙酮抢救。OP组的95%需要高剂量(>15mg/天)的美沙酮抢救。2日等效剂量的舒芬太尼或吗啡消耗没有差异,第四,发现了术后第6天。OFA+肠梗阻减少,恶心和呕吐(p<0.001)。与术前相比,OFA+组患者出院时的阿片类药物需求量降低了60.9%。显示抗焦虑药需求减少77%。
使用EDS-HT/JHS进行CCF的患者的OFA-plus管理显示,与基于阿片类药物的麻醉相比,术后疼痛和出院时显著减少。OFA+管理减少了美沙酮救援的总剂量,减少抗焦虑需求和胃肠道副作用,除了便秘.OFA-plus管理是改善术后疼痛控制的可行选择,EDS-HT/JHSCCF患者减少阿片类药物的使用及其术后副作用。