背景阿片类药物,通常用于控制与手术相关的疼痛,已知可以延长机械通气的持续时间和住院时间。目前广泛的辅助策略用于减少术后疼痛,如局部和局部神经阻滞,神经冷冻消融,和辅助药物。我们假设屈大麻酚(一种合成大麻素)与标准阿片类药物疼痛管理相结合将减少阿片类药物管理术后疼痛的需求。方法68例首次行单纯冠状动脉旁路移植术的患者随机分为对照组,他只接受了标准的阿片类药物镇痛,或屈大麻酚组,除了标准的阿片类药物镇痛外,还接受了屈大麻酚(一种合成大麻素)。术前单元给予屈大麻酚,在ICU拔管前,术后第一天拔管后。术前,术中,和术后参数根据IRB批准的方案进行比较.主要终点是术后阿片类药物的需求,机械通气的持续时间,和ICU住院时间,次要终点是所需的正性肌力支持的持续时间,左心室射血分数(LVEF),以及LVEF的变化。这项研究是在西北医学中心进行的,图森,AZ,美国。结果68例患者随机分为对照组(n=37)或屈大麻酚组(n=31)。群体在人口统计学特征和合并症方面相似。屈大麻酚组术后阿片类药物总需求量显著降低[39.62vs23.68吗啡毫克当量(MME),p=0.0037],代表40%的减少。机械通气持续时间(7.03vs6.03h,p=0.5004),ICU住院时间(71.43vs63.77h,p=0.4227),和正性肌力支持要求(0.6757vs0.6129天,p=0.7333)在对照组和屈大麻酚组中相似。然而,屈大麻酚组的每个终点的持续时间都有降低的趋势.有趣的是,屈大麻酚组术前到术后LVEF变化明显更好(3.51%vs6.45%,p=0.0451)。结论我们的研究发现,在接受屈大麻酚辅助治疗的患者中,阿片类药物的使用减少了40%,LVEF明显改善。机械通气时间,ICU住院时间,屈大麻酚组中的正性肌力支持需求趋于较低,虽然没有达到统计学意义。这项研究的结果,尽管受样本量的限制,非常令人鼓舞,并证实了我们正在进行的调查。
Background Opioids, commonly used to control pain associated with surgery, are known to prolong the duration of mechanical ventilation and length of hospital stay. A wide range of adjunctive strategies are currently utilized to reduce postoperative pain, such as local and regional nerve blocks, nerve cryoablation, and adjunctive medications. We hypothesized that dronabinol (a synthetic cannabinoid) in conjunction with standard opioid pain management will reduce opioid requirements to manage postoperative pain. Methods Sixty-eight patients who underwent isolated first-time coronary artery bypass graft surgery were randomized to either the control group, who received only standard opioid-based analgesia, or the dronabinol group, who received dronabinol (a synthetic cannabinoid) in addition to standard opioid-based analgesia. Dronabinol was given in the preoperative unit, before extubation in the ICU, and after extubation on the first postoperative day. Preoperative, intraoperative, and postoperative parameters were compared under an IRB-approved protocol. The primary endpoints were the postoperative opioid requirement, duration of mechanical ventilation, and ICU length of stay, and the secondary endpoints were the duration of inotropic support needed, left ventricular ejection fraction (LVEF), and the change in LVEF. This study was undertaken at Northwest Medical Center, Tucson, AZ, USA. Results Sixty-eight patients were randomized to either the control group (n = 37) or the dronabinol group (n = 31). Groups were similar in terms of demographic features and comorbidities. The total postoperative opioid requirement was significantly lower in the dronabinol group [39.62 vs 23.68 morphine milligram equivalents (MMEs), p = 0.0037], representing a 40% reduction. Duration of mechanical ventilation (7.03 vs 6.03h, p = 0.5004), ICU length of stay (71.43 vs 63.77h, p = 0.4227), and inotropic support requirement (0.6757 vs 0.6129 days, p = 0.7333) were similar in the control and the dronabinol groups. However, there was a trend towards lower durations in each endpoint in the dronabinol group. Interestingly, a significantly better preoperative to postoperative LVEF change was observed in the dronabinol group (3.51% vs 6.45%, p = 0.0451). Conclusions Our study found a 40% reduction in opioid use and a significantly greater improvement in LVEF in patients treated with adjunctive dronabinol. Mechanical ventilation duration, ICU length of stay, and inotropic support requirement tended to be lower in the dronabinol group, though did not reach statistical significance. The results of this study, although limited by sample size, are very encouraging and validate our ongoing investigation.