不同剂量鞘内舒芬太尼对老年下肢骨科手术患者术后疼痛缓解和阿片类药物消耗的影响:一项随机对照试验

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Journal of Pain Research Pub Date : 2025-05-15 eCollection Date: 2025-01-01 DOI:10.2147/JPR.S512653
Yan Li, Yinghua Gu, Wenxun Liu, Xin Liu, Fa Wang, Biyun Tian, Wei Zhou, Qingshan Ye
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引用次数: 0

摘要

老年下肢骨折手术患者首选细针等压脊髓麻醉。然而,单药局麻药受阻滞时间短、血流动力学不稳定和止痛不足的限制。鞘内舒芬太尼,作为辅助,增强镇痛,延长阻滞持续时间,促进恢复。然而,鞘内舒芬太尼的剂量依赖性效应仍未得到充分研究。本研究评估了该人群中不同剂量的鞘内舒芬太尼,旨在通过循证策略优化剂量。方法:将231例老年患者随机分为3组:B组(仅布比卡因)、BS1组(布比卡因+ 5 μg舒芬太尼)和BS2组(布比卡因+ 10 μg舒芬太尼)。我们评估了基线数据、感觉和运动阻滞特征、NRS评分、救援阿片类药物消耗和并发症。结果:与B组(中位数= 2 min)相比,BS1和BS2的运动阻滞发作延迟(中位数= 3 min),但运动阻滞持续时间明显延长(BS2: 279.5 min, P = 0.001;BS1组:268.0 min, P = 0.022 vs B组:223.0 min)。术后第2天,BS1组和BS2组NRS评分较b组低,镇痛药使用较少。BS1组恶心多见,BS2组瘙痒加重。术后第1天BS2低氧血症最高。结论:布比卡因联合舒芬太尼是一种安全有效的方案,可延长镇痛时间,减少术后疼痛和阿片类药物的使用。BS2(布比卡因+ 10 μg舒芬太尼)对疼痛的缓解效果最好,是高度疼痛控制需求的理想选择,但BS2较高的瘙痒和低氧血症提示根据患者耐受性仔细调整剂量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of Intrathecal Sufentanil at Different Doses on Postoperative Pain Relief and Opioid Consumption in Elderly Patients Undergoing Lower Limb Orthopedic Surgery: A Randomized Controlled Trial.

Introduction: Fine-needle isobaric spinal anesthesia is preferred for elderly patients undergoing lower limb fracture surgery. However, single-agent local anesthetics are limited by short block duration, hemodynamic instability, and inadequate analgesia. Intrathecal sufentanil, as an adjunct, enhances analgesia, prolongs block duration, and promotes recovery. Yet, the dose-dependent effects of intrathecal sufentanil remain understudied. This study evaluates different doses of intrathecal sufentanil in this population, aiming to optimize dosing through evidence-based strategies.

Methods: We randomly allocated 231 elderly patients into three groups: Group B (bupivacaine only), Group BS1 (bupivacaine + 5 μg sufentanil), and Group BS2 (bupivacaine + 10 μg sufentanil). We assessed baseline data, sensory and motor block characteristics, NRS scores, rescue opioid consumption, and complications.

Results: BS1 and BS2 had delayed motor block onset (median = 3 min) compared to Group B (median = 2 min), but significantly longer motor block duration (BS2: 279.5 min, P = 0.001; BS1: 268.0 min, P = 0.022 vs Group B: 223.0 min). On postoperative day 2, BS1 and BS2 showed lower NRS scores and less analgesic use than Group B. Nausea was most common in BS1, while pruritus increased in BS2. Hypoxemia was highest in BS2 on postoperative day 1.

Conclusion: Bupivacaine and sufentanil combined is a safe and effective regimen, prolonging analgesia and reducing postoperative pain and opioid use. BS2 (bupivacaine + 10 μg sufentanil) provided the best pain relief, ideal for high pain control needs, but higher pruritus and hypoxemia in BS2 suggest careful dosage adjustment based on patient tolerance.

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来源期刊
Journal of Pain Research
Journal of Pain Research CLINICAL NEUROLOGY-
CiteScore
4.50
自引率
3.70%
发文量
411
审稿时长
16 weeks
期刊介绍: Journal of Pain Research is an international, peer-reviewed, open access journal that welcomes laboratory and clinical findings in the fields of pain research and the prevention and management of pain. Original research, reviews, symposium reports, hypothesis formation and commentaries are all considered for publication. Additionally, the journal now welcomes the submission of pain-policy-related editorials and commentaries, particularly in regard to ethical, regulatory, forensic, and other legal issues in pain medicine, and to the education of pain practitioners and researchers.
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