鞘内吗啡和罗哌卡因对腹腔镜结直肠手术后恢复质量的影响：一项随机对照试验。

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2024-12-18 eCollection Date: 2024-01-01 DOI:10.2147/DDDT.S500316

Ying Yang, Wenjun Lin, Yifen Zhuo, Yuxin Luo, Xiaoyan Wu, Junyu Li, Yusheng Yao

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引用次数: 0

摘要

目的：鞘内吗啡越来越多地用于腹腔镜结直肠手术的疼痛管理。虽然与布比卡因相比，罗哌卡因具有降低心脏毒性和更快运动恢复的优点，但鞘内吗啡-罗哌卡因联合使用对术后恢复质量的影响尚不清楚。本研究旨在评估这种组合对腹腔镜结直肠手术后恢复结果的影响。患者和方法：在这项随机、双盲、安慰剂对照的试验中，78名接受腹腔镜结肠直肠癌手术的患者接受不含防腐剂的鞘内吗啡250 μg加罗哌卡因15 mg（鞘内组）或假皮下生理盐水注射（对照组）。主要观察指标为术后24小时的恢复质量-15 （QoR-15）评分。次要结局包括疼痛评分、阿片类药物消耗和不良反应。结果：鞘内组术后24小时QoR-15评分明显高于对照组（中位[IQR]: 121 [109-128] vs 111 [102-116]， p < 0.001），疼痛管理（p < 0.001）、身体舒适度（p = 0.001）和身体独立性（p = 0.002）均有改善。鞘内组在休息时（0-48小时曲线下面积：66 [59-90]vs 107 [89-126]， p < 0.001）和咳嗽时（152 [137-172]vs 191 [166-213], p < 0.001）疼痛评分较低，特别是在0.5至24小时。患者术后吗啡用量也较少（0-48小时：10 [6-20]vs 26 [22-36] mg， p < 0.001）。鞘内组低血压（43.6% vs 17.9%, p = 0.014）和瘙痒（35.9% vs 2.6%, p < 0.001）发生率更高，但两组均未发生呼吸抑制。结论：鞘内给药吗啡-罗哌卡因提高了腹腔镜结直肠手术后24小时的恢复质量，并提供了良好的疼痛缓解，尽管副作用增加但可控。进一步的研究应侧重于剂量优化和不同鞘内局麻组合的比较研究。试验注册：中国临床试验注册中心，ChiCTR2100052337。

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Intrathecal Morphine and Ropivacaine for Quality of Recovery After Laparoscopic Colorectal Surgery: A Randomized Controlled Trial.

Purpose: Intrathecal morphine is increasingly used for pain management in laparoscopic colorectal surgery. While ropivacaine shows advantages of reduced cardiotoxicity and faster motor recovery compared to bupivacaine, the impact of intrathecal morphine-ropivacaine combination on postoperative recovery quality remains unclear. This study aimed to evaluate this combination's effect on recovery outcomes after laparoscopic colorectal surgery.

Patients and methods: In this randomized, double-blind, placebo-controlled trial, 78 patients undergoing laparoscopic colorectal surgery received either preservative-free intrathecal morphine 250 μg with ropivacaine 15 mg (Intrathecal group) or a sham subcutaneous saline injection (Control group). The primary outcome was the Quality of Recovery-15 (QoR-15) score 24 hours after surgery. Secondary outcomes included pain scores, opioid consumption, and adverse effects.

Results: The intrathecal group showed significantly higher QoR-15 scores 24 hours postoperatively compared to the control group (median [IQR]: 121 [109-128] vs 111 [102-116], p < 0.001), with improvements in pain management (p < 0.001), physical comfort (p = 0.001), and physical independence (p = 0.002). The intrathecal group had lower pain scores at rest (area under the curve 0-48 h: 66 [59-90] vs 107 [89-126], p < 0.001) and during coughing (152 [137-172] vs 191 [166-213], p < 0.001), particularly from 0.5 to 24 hours. They also required less postoperative morphine (0-48 h: 10 [6-20] vs 26 [22-36] mg, p < 0.001). While hypotension (43.6% vs 17.9%, p = 0.014) and pruritus (35.9% vs 2.6%, p < 0.001) were more frequent in the intrathecal group, but no respiratory depression occurred in either group.

Conclusion: Intrathecal morphine-ropivacaine administration improves 24-hour postoperative recovery quality and provides superior pain relief after laparoscopic colorectal surgery, despite increased but manageable side effects. Further research should focus on dose optimization and comparative studies of different intrathecal local anesthetic combinations.

Trial registration: The Chinese Clinical Trial Registry, ChiCTR2100052337.

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.