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Abstract：
Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic.
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.
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.
摘要：
Ehlers-Danlos综合征/过度活动型（EDS-HT/JHS）和颅颈不稳定患者经常遭受严重的广泛性疼痛，难以控制。慢性神经炎症,阿片类药物诱导的痛觉过敏，中枢致敏可以解释这种痛苦的情况。这项研究的目的是确定是否无阿片类药物麻醉加利多卡因术后给药，氯胺酮和右美托咪定可以减少术后疼痛和美沙酮抢救的需要,与阿片类药物治疗相比,这些患者接受颈内固定术(CCF).次要目的是评估出院时阿片类药物的需求，胃肠道并发症的发生率和抗焦虑药的需求。
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。
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。
