目的:微血管减压术(MVD)术后常发生恶心呕吐(PONV)。芬太尼,阿片类药物,与PONV的发展密切相关,和酮咯酸,一种非甾体抗炎药,已被批准用于术后疼痛管理。然而,目前尚不清楚基于酮咯酸的患者自控镇痛(PCA)在MVD后如何引起PONV,或其疗效与基于芬太尼的PCA有何不同.在这项研究中,作者比较了基于酮咯酸和基于芬太尼的PCA在MVD后PONV的发生率和严重程度以及镇痛方面的差异.
方法:这种前瞻性,双盲,单中心,从2021年12月至2023年2月进行的随机对照试验纳入了MVD患者,这些患者在术后被随机分配至基于酮洛拉酸或芬太尼的PCA组.术后前48小时确定PONV的发生率(主要结果)和严重程度以及抢救止吐需求。此外,术后疼痛评分,抢救镇痛需求,PCA用法,在研究期间评估满意度评分。PONV严重程度和术后疼痛评分采用11分数字评定量表(0=无,10=极端)。确定PONV和疼痛的满意度评分(0=非常不满意,10=非常满意)。使用卡方或Fisher精确检验分析分类变量。使用基于正态分布的Studentt检验或Mann-WhitneyU检验分析连续变量。
结果:在185名筛查患者中,根据预定的排除标准排除91例;分析了87例患者(酮咯酸组43例,芬太尼组44例),两组之间的人口统计学数据没有显着差异。PONV发生率(48.8%vs79.5%,基于酮咯酸的PCA组的p=0.003)和严重程度(p=0.004)低于基于芬太尼的PCA组。在酮咯酸组中,与芬太尼组相比,抢救止吐需求显著降低(p=0.049).酮咯酸PCA组的停药次数低于芬太尼PCA组(p=0.001),而两组术后疼痛无显著差异。
结论:在MVD患者中,与基于芬太尼的PCA相比,基于酮咯酸的PCA降低了PONV的发生率和严重程度,镇痛效果类似于基于芬太尼的PCA。这项研究提供了临床证据,表明基于酮咯酸的PCA可能是术后护理中基于芬太尼的PCA的有效替代方法。
OBJECTIVE: Postoperative nausea and vomiting (PONV) occurs frequently after microvascular decompression (MVD). Fentanyl, an opioid, is strongly related to the development of PONV, and ketorolac, a nonsteroidal anti-inflammatory drug, has been approved for postoperative pain management. However, how ketorolac-based patient-controlled analgesia (PCA) causes PONV or how its efficacy differs from that of fentanyl-based PCA after MVD is unclear. In this
study, the authors compared ketorolac-based with fentanyl-based PCA in terms of the incidence and severity of PONV and analgesia after MVD.
METHODS: This prospective, double-blind, single-center, randomized controlled
trial conducted from December 2021 to February 2023 included patients with MVD who were randomly allocated to the ketorolac- or fentanyl-based PCA group postoperatively. The incidence (primary outcome) and severity of PONV and rescue antiemetic requirements were determined during the first 48 hours postoperatively. Additionally, postoperative pain scores, rescue analgesic requirement, PCA usage, and satisfaction scores were assessed during the
study period. PONV severity and postoperative pain scores were assessed using an 11-point numeric rating scale (0 = none, 10 = extremely). Satisfaction scores for PONV and pain were determined (0 = very dissatisfied, 10 = very satisfied). Categorical variables were analyzed using the chi-square or Fisher\'s exact test. Continuous variables were analyzed using the Student t-test or Mann-Whitney U-test based on normal distribution.
RESULTS: Of 185 screened patients, 91 were excluded based on predetermined exclusion criteria; 87 patients (43 in the ketorolac group and 44 in the fentanyl group) were analyzed and showed no significant differences in demographic data between groups. PONV incidence (48.8% vs 79.5%, p = 0.003) and severity (p = 0.004) were lower in the ketorolac-based PCA group than in the fentanyl-based PCA group. In the ketorolac group, there was a significant reduction in rescue antiemetic requirements compared with the fentanyl group (p = 0.049). The number of discontinuations was lower in the ketorolac-based PCA group than in the fentanyl-based PCA group (p = 0.001), whereas no significant differences in postoperative pain were found between the two groups.
CONCLUSIONS: In patients with MVD, ketorolac-based PCA resulted in a decrease in PONV incidence and severity compared with fentanyl-based PCA, with analgesic effects similar to those of fentanyl-based PCA. This
study provides clinical evidence that ketorolac-based PCA may be a valid alternative to fentanyl-based PCA in postoperative care.