Abstract：
OBJECTIVE: This study aimed to investigate the effects of opioid-free anesthesia (OFA) in laparoscopic gastrectomy and identify the psychological factors that could influence the efficacy of OFA.
METHODS: 120 patients undergoing laparoscopic gastrectomy were allocated to either the opioid-based anesthesia group (OA) (n = 60) or the OFA (n = 60) group. Remifentanil was administered to the OA group intraoperatively, whereas dexmedetomidine and lidocaine were administered to the OFA group. The interaction effect of the psychological factors on OFA was analyzed using the aligned rank transform for nonparametric factorial analyses.
RESULTS: The opioid requirement for 24 h after surgery was lower in the OFA group than in the OA group (fentanyl equivalent dose 727 vs. 650 μg, p = 0.036). The effect of OFA was influenced by the pain catastrophizing scale (p = 0.041), temporal pain summation (p = 0.046), and pressure pain tolerance (p = 0.034). This indicates that patients with pain catastrophizing or high pain sensitivity significantly benefited from OFA, whereas patients without these characteristics did not.
CONCLUSIONS: This study demonstrated that OFA with dexmedetomidine and lidocaine effectively reduced the postoperative 24-h opioid requirements following laparoscopic gastrectomy, which was modified by baseline pain catastrophizing and pain sensitivity.
BACKGROUND: The study protocol was approved by the Institutional Review Board of Yonsei University Health System Gangnam Severance Hospital (#3-2021-0295) and registered at ClinicalTrials.gov (NCT05076903).
METHODS: 120 patients undergoing laparoscopic gastrectomy were allocated to either the opioid-based anesthesia group (OA) (n = 60) or the OFA (n = 60) group. Remifentanil was administered to the OA group intraoperatively, whereas dexmedetomidine and lidocaine were administered to the OFA group. The interaction effect of the psychological factors on OFA was analyzed using the aligned rank transform for nonparametric factorial analyses.
RESULTS: The opioid requirement for 24 h after surgery was lower in the OFA group than in the OA group (fentanyl equivalent dose 727 vs. 650 μg, p = 0.036). The effect of OFA was influenced by the pain catastrophizing scale (p = 0.041), temporal pain summation (p = 0.046), and pressure pain tolerance (p = 0.034). This indicates that patients with pain catastrophizing or high pain sensitivity significantly benefited from OFA, whereas patients without these characteristics did not.
CONCLUSIONS: This study demonstrated that OFA with dexmedetomidine and lidocaine effectively reduced the postoperative 24-h opioid requirements following laparoscopic gastrectomy, which was modified by baseline pain catastrophizing and pain sensitivity.
BACKGROUND: The study protocol was approved by the Institutional Review Board of Yonsei University Health System Gangnam Severance Hospital (#3-2021-0295) and registered at ClinicalTrials.gov (NCT05076903).
摘要：
目的：本研究旨在探讨无阿片类药物麻醉（OFA）在腹腔镜胃切除术中的效果，并确定可能影响OFA疗效的心理因素。
方法：120例腹腔镜胃切除术患者被分为阿片类药物麻醉组（OA）（n=60）或OFA组（n=60）。OA组术中给予瑞芬太尼,OFA组给予右美托咪定和利多卡因。使用对齐秩变换进行非参数阶乘分析，分析了心理因素对OFA的交互作用。
结果：OFA组术后24小时的阿片类药物需求量低于OA组（芬太尼等效剂量727与650μg,p=0.036)。OFA的效果受疼痛灾难量表的影响（p=0.041），颞部疼痛总和（p=0.046），和压力疼痛耐受性（p=0.034）。这表明疼痛灾难化或高疼痛敏感性的患者从OFA中显著受益，而没有这些特征的患者没有。
结论：这项研究表明，右美托咪定和利多卡因的OFA有效降低了腹腔镜胃切除术后24小时阿片类药物的需求，通过基线疼痛灾难化和疼痛敏感性对其进行了修改。
背景：该研究方案由延世大学卫生系统江南遣散医院（＃3-2021-0295）的机构审查委员会批准，并在ClinicalTrials.gov（NCT05076903）注册。
方法：120例腹腔镜胃切除术患者被分为阿片类药物麻醉组（OA）（n=60）或OFA组（n=60）。OA组术中给予瑞芬太尼,OFA组给予右美托咪定和利多卡因。使用对齐秩变换进行非参数阶乘分析，分析了心理因素对OFA的交互作用。
结果：OFA组术后24小时的阿片类药物需求量低于OA组（芬太尼等效剂量727与650μg,p=0.036)。OFA的效果受疼痛灾难量表的影响（p=0.041），颞部疼痛总和（p=0.046），和压力疼痛耐受性（p=0.034）。这表明疼痛灾难化或高疼痛敏感性的患者从OFA中显著受益，而没有这些特征的患者没有。
结论：这项研究表明，右美托咪定和利多卡因的OFA有效降低了腹腔镜胃切除术后24小时阿片类药物的需求，通过基线疼痛灾难化和疼痛敏感性对其进行了修改。
背景：该研究方案由延世大学卫生系统江南遣散医院（＃3-2021-0295）的机构审查委员会批准，并在ClinicalTrials.gov（NCT05076903）注册。
