Jian-Shun Zhou, Zhen Chen, Ying-Ying Liu, Mao-Lin Zhong, Qiong Zhong, Jun Wei, Qian Hu, Jia-Sheng Wang, Li-Feng Wang
{"title":"观察经皮内窥镜经椎间孔椎间盘切除术中使用不同剂量的艾司他敏和右美托咪定组合的镇痛效果：随机双盲对照试验","authors":"Jian-Shun Zhou, Zhen Chen, Ying-Ying Liu, Mao-Lin Zhong, Qiong Zhong, Jun Wei, Qian Hu, Jia-Sheng Wang, Li-Feng Wang","doi":"10.1007/s40263-024-01083-2","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Percutaneous endoscopic transforaminal discectomy (PETD) is an effective method for treating lumbar disc herniation, and is typically performed under local anesthesia. However, inadequate analgesia during the procedure remains a concern, prompting the search for a medication that can provide optimal pain control with minimal impact on the respiratory and circulatory systems.</p><h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>The aim of this study was to observe the effects of different doses of esketamine combined with dexmedetomidine on reducing visual analog scale (VAS) scores during surgical interventions.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>One hundred two patients who underwent PETD were randomly divided into a control group (group C: normal saline + dexmedetomidine), an E1 group (0.1 mg kg<sup>−1</sup> esketamine + dexmedetomidine), and an E2 group (0.2 mg kg<sup>−1</sup> esketamine + dexmedetomidine). The primary outcome was the maximum visual analogue scale (VAS) (score: 0 = no pain and 10 = worst pain) at six time points. The secondary outcomes included the Assessment of Alertness/Sedation Scale (OAA/S) score and mean arterial pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO<sub>2</sub>) at 11 time points. The incidence of adverse reactions during and 24 h after the operation and patient satisfaction with the anesthesia were also recorded.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Compared with those in group C, the VAS scores of patients in groups E1 and E2 were lower at <i>T</i><sub>6</sub>, <i>T</i><sub>7</sub>, and <i>T</i><sub>9</sub> (<i>P</i> < 0.05). From <i>T</i><sub>4</sub> to <i>T</i><sub>10</sub>, the OAA/S scores of the E1 and E2 groups were both lower than those of group C (<i>P</i> < 0.05), and at the <i>T</i><sub>4</sub>–<i>T</i><sub>6</sub> time points, the OAA/S score of the E2 group was lower than that of group E1 (<i>P</i> < 0.05). At <i>T</i><sub>4</sub> and <i>T</i><sub>5</sub>, the HR and BP of patients in groups E1 and E2 were greater than those in group C (<i>P</i> < 0.05). Compared with those in group C, the incidences of intraoperative illusion, floating sensation, postoperative dizziness, and hyperalgesia in groups E1 and E2 were significantly greater (<i>P</i> < 0.01). There was no significant difference in patient RR, SpO<sub>2</sub>, or postoperative satisfaction with anesthesia among the three groups (<i>P</i> > 0.05).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The combination of esketamine and dexmedetomidine can reduce VAS scores during certain stages of this type of surgery; it has minimal impact on respiration and circulation. However, this approach is associated with increased incidences of postoperative dizziness and psychiatric side effects, which may also affect patients’ compliance with surgical instructions from medical staff. Patient satisfaction was not greater with dexmedetomidine combined with esketamine than with dexmedetomidine alone.</p><h3 data-test=\"abstract-sub-heading\">Trial Registration</h3><p>http://www.chictr.org.cn. Identifier: ChiCTR2300068206. Date of registration: 10 February 2023.</p>","PeriodicalId":10508,"journal":{"name":"CNS drugs","volume":"48 1","pages":""},"PeriodicalIF":7.4000,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Observation on the Analgesic Effect of Different Doses of a Combination of Esketamine and Dexmedetomidine Administered for Percutaneous Endoscopic Transforaminal Discectomy: A Randomized, Double-Blind Controlled Trial\",\"authors\":\"Jian-Shun Zhou, Zhen Chen, Ying-Ying Liu, Mao-Lin Zhong, Qiong Zhong, Jun Wei, Qian Hu, Jia-Sheng Wang, Li-Feng Wang\",\"doi\":\"10.1007/s40263-024-01083-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background</h3><p>Percutaneous endoscopic transforaminal discectomy (PETD) is an effective method for treating lumbar disc herniation, and is typically performed under local anesthesia. However, inadequate analgesia during the procedure remains a concern, prompting the search for a medication that can provide optimal pain control with minimal impact on the respiratory and circulatory systems.</p><h3 data-test=\\\"abstract-sub-heading\\\">Objectives</h3><p>The aim of this study was to observe the effects of different doses of esketamine combined with dexmedetomidine on reducing visual analog scale (VAS) scores during surgical interventions.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>One hundred two patients who underwent PETD were randomly divided into a control group (group C: normal saline + dexmedetomidine), an E1 group (0.1 mg kg<sup>−1</sup> esketamine + dexmedetomidine), and an E2 group (0.2 mg kg<sup>−1</sup> esketamine + dexmedetomidine). The primary outcome was the maximum visual analogue scale (VAS) (score: 0 = no pain and 10 = worst pain) at six time points. The secondary outcomes included the Assessment of Alertness/Sedation Scale (OAA/S) score and mean arterial pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO<sub>2</sub>) at 11 time points. The incidence of adverse reactions during and 24 h after the operation and patient satisfaction with the anesthesia were also recorded.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Compared with those in group C, the VAS scores of patients in groups E1 and E2 were lower at <i>T</i><sub>6</sub>, <i>T</i><sub>7</sub>, and <i>T</i><sub>9</sub> (<i>P</i> < 0.05). From <i>T</i><sub>4</sub> to <i>T</i><sub>10</sub>, the OAA/S scores of the E1 and E2 groups were both lower than those of group C (<i>P</i> < 0.05), and at the <i>T</i><sub>4</sub>–<i>T</i><sub>6</sub> time points, the OAA/S score of the E2 group was lower than that of group E1 (<i>P</i> < 0.05). At <i>T</i><sub>4</sub> and <i>T</i><sub>5</sub>, the HR and BP of patients in groups E1 and E2 were greater than those in group C (<i>P</i> < 0.05). Compared with those in group C, the incidences of intraoperative illusion, floating sensation, postoperative dizziness, and hyperalgesia in groups E1 and E2 were significantly greater (<i>P</i> < 0.01). There was no significant difference in patient RR, SpO<sub>2</sub>, or postoperative satisfaction with anesthesia among the three groups (<i>P</i> > 0.05).</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusion</h3><p>The combination of esketamine and dexmedetomidine can reduce VAS scores during certain stages of this type of surgery; it has minimal impact on respiration and circulation. However, this approach is associated with increased incidences of postoperative dizziness and psychiatric side effects, which may also affect patients’ compliance with surgical instructions from medical staff. Patient satisfaction was not greater with dexmedetomidine combined with esketamine than with dexmedetomidine alone.</p><h3 data-test=\\\"abstract-sub-heading\\\">Trial Registration</h3><p>http://www.chictr.org.cn. Identifier: ChiCTR2300068206. 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Observation on the Analgesic Effect of Different Doses of a Combination of Esketamine and Dexmedetomidine Administered for Percutaneous Endoscopic Transforaminal Discectomy: A Randomized, Double-Blind Controlled Trial
Background
Percutaneous endoscopic transforaminal discectomy (PETD) is an effective method for treating lumbar disc herniation, and is typically performed under local anesthesia. However, inadequate analgesia during the procedure remains a concern, prompting the search for a medication that can provide optimal pain control with minimal impact on the respiratory and circulatory systems.
Objectives
The aim of this study was to observe the effects of different doses of esketamine combined with dexmedetomidine on reducing visual analog scale (VAS) scores during surgical interventions.
Methods
One hundred two patients who underwent PETD were randomly divided into a control group (group C: normal saline + dexmedetomidine), an E1 group (0.1 mg kg−1 esketamine + dexmedetomidine), and an E2 group (0.2 mg kg−1 esketamine + dexmedetomidine). The primary outcome was the maximum visual analogue scale (VAS) (score: 0 = no pain and 10 = worst pain) at six time points. The secondary outcomes included the Assessment of Alertness/Sedation Scale (OAA/S) score and mean arterial pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) at 11 time points. The incidence of adverse reactions during and 24 h after the operation and patient satisfaction with the anesthesia were also recorded.
Results
Compared with those in group C, the VAS scores of patients in groups E1 and E2 were lower at T6, T7, and T9 (P < 0.05). From T4 to T10, the OAA/S scores of the E1 and E2 groups were both lower than those of group C (P < 0.05), and at the T4–T6 time points, the OAA/S score of the E2 group was lower than that of group E1 (P < 0.05). At T4 and T5, the HR and BP of patients in groups E1 and E2 were greater than those in group C (P < 0.05). Compared with those in group C, the incidences of intraoperative illusion, floating sensation, postoperative dizziness, and hyperalgesia in groups E1 and E2 were significantly greater (P < 0.01). There was no significant difference in patient RR, SpO2, or postoperative satisfaction with anesthesia among the three groups (P > 0.05).
Conclusion
The combination of esketamine and dexmedetomidine can reduce VAS scores during certain stages of this type of surgery; it has minimal impact on respiration and circulation. However, this approach is associated with increased incidences of postoperative dizziness and psychiatric side effects, which may also affect patients’ compliance with surgical instructions from medical staff. Patient satisfaction was not greater with dexmedetomidine combined with esketamine than with dexmedetomidine alone.
Trial Registration
http://www.chictr.org.cn. Identifier: ChiCTR2300068206. Date of registration: 10 February 2023.
期刊介绍：
CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes:
- Overviews of contentious or emerging issues.
- Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses.
- Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement.
- Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry.
- Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies.
Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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