PDF(Pubmed)
Abstract：
Minimization of intra-operative opioid use is an area of ongoing research interest with several potential benefits to the patient. Pre-emptive analgesia, defined as the administration of an analgesic before surgery to prevent establishment of central sensitization of pain, is one avenue that has been explored to achieve this. A retrospective observational study was undertaken to examine the effect of pre-emptive paracetamol on intra-operative opioid requirements. The medical and operative data of 156 patients who underwent day-case wide local excision and sentinel lymph node biopsy with and without regional block surgery at our center between October 2019 and May 2022 was carried out. Data were collected on demographics, total intra-operative and immediate post-operative opioid consumption. 57 patients did not receive pre-emptive paracetamol while 90 did. Baseline characteristics were similar. Our results showed a statistically significant reduction in morphine (p <0.029) and remifentanil (p <0.007) consumption in patients who received a regional block and pre-emptive paracetamol. Those who did not receive a regional block and were given pre-emptive paracetamol had a decrease in OxyNorm (p <0.022) requirements. A combination of general anesthesia (GA), regional block and pre-emptive paracetamol reduced intra-operative consumption of Fentanyl, OxyNorm, diclofenac, dexketoprofen, and clonidine (P <0.001) when compared to just GA alone. Use of pre-emptive paracetamol in reduction of intra-operative opioid requirements showed promising results but larger studies may strengthen the evidence for this association. A multimodal analgesic approach that utilizes pre-emptive paracetamol can be a viable method to decrease intra-operative of analgesic requirements.
摘要：
术中阿片类药物使用的最小化是正在进行的研究兴趣的领域,其对患者具有若干潜在益处。超前镇痛,定义为在手术前给予镇痛剂以防止建立中枢致敏的疼痛，是实现这一目标的一种途径。进行了一项回顾性观察性研究，以检查先发制人的扑热息痛对术中阿片类药物需求的影响。在2019年10月至2022年5月期间，我们中心进行了156例患者的医学和手术数据，这些患者在有或没有进行区域阻滞手术的情况下进行了日间局部切除和前哨淋巴结活检。收集了人口统计数据，术中和术后立即消耗阿片类药物。57名患者没有接受先发制人的扑热息痛，而90名患者接受了扑热息痛。基线特征相似。我们的结果显示，在接受区域性阻滞和先发制人扑热息痛的患者中，吗啡（p<0.029）和瑞芬太尼（p<0.007）的消耗在统计学上显着降低。那些没有接受区域性阻滞并给予先发制人扑热息痛的患者的OxyNorm要求降低（p<0.022）。全身麻醉（GA）的组合，局部阻滞和先发制人的扑热息痛减少了术中芬太尼的消耗，OxyNorm,双氯芬酸,右旋酮洛芬,和可乐定（P<0.001）与仅GA相比。使用先发制人的扑热息痛减少术中阿片类药物的需求显示出令人鼓舞的结果，但更大的研究可能会加强这种关联的证据。利用先发制人的扑热息痛的多模式镇痛方法可能是减少术中镇痛需求的可行方法。
