术中高氧不能减轻术后疼痛：交叉队列试验的亚组分析
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Intraoperative Hyperoxia Does Not Reduce Postoperative Pain: Subanalysis of an Alternating Cohort Trial
背景与目的
术后疼痛是常见的，且会增加阿片类药物的使用。由于正常灌注受损，外科伤口缺氧。局部伤口缺血和酸中毒可引起切口疼痛。一些证据表明，改善外科伤口的氧气供应可能会减轻疼痛。因此，本试验旨在验证一个假设，即术中高氧(吸入氧气浓度为80%)可以减少术后疼痛和阿片类药物的使用。
方 法
我们对一项大型单中心交替队列试验进行了进一步分析，该试验将进行结肠直肠手术的全麻手术患者的术中氧浓度分为30%或80%两组，一个试验阶段为2周，共39个月。无论哪种氧浓度，患者都能获得足够的氧气维持95%的氧饱和度。排除进行区域麻醉或神经阻滞的病人。主要结果是分析在术后最初2小时疼痛程度和阿片类药物消耗量。次要结果是术后24小时的疼痛程度和阿片类药物消耗量。主要结果的亚组分析了开腹手术与腹腔镜手术以及有无慢性疼痛的患者。
结 果
共有4702例患者符合条件:2415例给予80%吸入氧，2287例给予30%吸入氧。这两组在潜在的混杂因素上保持平衡。两组患者的平均疼痛评分和阿片类药物消耗量相似(疼痛评分的平均差异为-0.01 [97.5% CI,- 0.16 ~ 0.14;P =0 .45，阿片类药物消耗量的中位差异0.0 [97.5% CI, 0至0]mg吗啡当量;P =0 .82)。次要结果和亚组分析也没有显著差异。
结 论
术中高氧（吸入氧气浓度为80%）不能减少术后急性疼痛或阿片类药物的消耗。
原始文献摘要
Barak Cohen, Sanchit Ahuja, Yehoshua N. Schacham, et al.Intraoperative Hyperoxia Does Not Reduce Postoperative Pain: Subanalysis of an Alternating Cohort Trial [J].Anesth Analg 2019;128:1160–1166
BACKGROUND: Postoperative pain is common and promotes opioid use. Surgical wounds are hypoxic because normal perfusion is impaired. Local wound ischemia and acidosis promote incisional pain. Some evidence suggests that improving oxygen supply to surgical wounds might reduce pain. We therefore tested the hypothesis that supplemental (80% inspired) intraoperative oxygen reduces postoperative pain and opioid consumption.
METHODS: We conducted a post hoc analysis of a large, single-center alternating cohort trial allocating surgical patients having general anesthesia for colorectal surgery to either 30% or 80% intraoperative oxygen concentration in 2-week blocks for a total of 39 months. Irrespective of allocation, patients were given sufficient oxygen to maintain saturation 95%. Patients who had regional anesthesia or nerve blocks were excluded. The primary outcome was pain and opioid consumption during the initial 2 postoperative hours, analyzed jointly. The secondary outcome was pain and opioid consumption over the subsequent 24 postoperative hours. Subgroup analyses of the primary outcome were conducted for open versus laparoscopic procedures and for patients with versus without chronic pain.
RESULTS: A total of 4702 cases were eligible for analysis: 2415 were assigned to 80% oxygen and 2287 to 30% oxygen. The groups were well balanced on potential confounding factors. Average pain scores and opioid consumption were similar between the groups (mean difference in pain scores, -0.01 [97.5% CI, -0.16 to 0.14; P = 0.45], median difference in opioid consumption, 0.0 [97.5% CI, 0 to 0] mg morphine equivalents; P =0 .82). There were also no significant differences in the secondary outcome or subgroup analyses.
CONCLUSIONS: Supplemental intraoperative oxygen does not reduce acute postoperative pain or reduce opioid consumption.
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贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙