罗哌卡因伤口浸润联合静脉注射氟比洛芬酯的多模式镇痛为甲状腺根治术后患者提供了良好的镇痛效果：一项随机对照试验
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Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy: a randomized controlled trial
背景与目的
甲状腺切除术是一种常见的可导致轻微创伤的手术方法。然而，术后疼痛仍然是患者护理中的主要挑战。包含镇痛药和镇痛技术的组合的多模式镇痛在控制术后疼痛方面已变得越来越流行。本研究验证了在甲状腺根治术后罗哌卡因伤口浸润和静脉注射氟比洛芬酯复合镇痛比单剂量曲马多镇痛效果更好的假设。
方 法
这项随机对照试验在一家三级医院进行。将计划进行根治性甲状腺切除术的44名患者（年龄18-75岁;ASA分级为I/II; BMI <32 kg / m2）随机分配到多模式镇痛组（M组）或对照组（C组），共40名患者完成了研究。所有参与者和负责后续观察的护士都对小组分配不知情。用舒芬太尼、丙泊酚和顺式阿曲库铵诱导麻醉。气管插管后，M组接受切口前伤口浸润，用5ml 0.5％罗哌卡因与肾上腺素以1：200,000（5μg/ ml）混合;C组未接受伤口浸润。通过靶控输注丙泊酚、瑞芬太尼、七氟醚和间歇性给予顺式阿曲库铵维持麻醉。在手术结束前20分钟，M组接受100mg氟比洛芬酯，而C组接受100mg曲马多。用数字评定量表（NRS）评估术后疼痛。术中记录瑞芬太尼的消耗量、心率和无创血压。记录不良事件发生情况。主要观察指标是根据NRS评分评估镇痛效果。
结 果
M组在出麻醉恢复室前(P=0.003)、术后2h(P=0.008)、4h(P=0.020)和8 h(P=0.016)NRS评分明显低于C组。M组在拔管后5 min(p=0.017)，出麻醉恢复室前(p=0.001)，术后2h(p=0.002)，4h(p=0.013)时咳嗽/吞咽的NRS评分明显降低。与C组相比，静息时（M = 0.008）和咳嗽/吞咽期间（P = 0.003），M组术后第一个24小时的NRS评分显著降低。两组均未观察到严重不良事件。
结 论
罗哌卡因伤口浸润联合静脉注射氟比洛芬酯的多模式镇痛比曲马多在根治性甲状腺切除术后具有更好的镇痛效果。
原始文献摘要
Li X, Yu L, Yang J, et al. Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy: a randomized controlled trial.[J] .BMC Anesthesiol, 2019, 19: 167.
Background: Thyroidectomy is a common procedure that causes mild trauma. Nevertheless, postoperative pain remains a major challenge in patient care. Multimodal analgesia comprising a combination of analgesics and analgesic techniques has become increasingly popular for the control of postoperative pain. The present study tested the hypothesis that multimodal analgesia with combined ropivacaine wound infiltration and
intravenous flurbiprofen axetil after radical thyroidectomy provided better analgesia than a single dosage of tramadol.
Methods:This randomized controlled trial was conducted in a tertiary hospital. Forty-four patients (age, 18–75 years; American Society of Anesthesiologists status I or II; BMI < 32 kg/m2) scheduled for radical thyroidectomy were randomly assigned to a multimodal analgesia group (Group M) or a control group (Group C) by random numbers assignments, and 40 patients completed the study. All participants and the nurse in charge of follow-up observations were blinded to group assignment. Anesthesia was induced with sufentanil, propofol, and cisatracurium. After tracheal intubation, Group M received pre-incision wound infiltration with 5 ml of 0.5% ropivacaine mixed with epinephrine at 1:200,000 (5 μg/ml); Group C received no wound infiltration. Anesthesia was maintained with target-controlled infusion of propofol, remifentanil, sevoflurane, and intermittent cisatracurium. Twenty minutes before the end of surgery, Group M received 100 mg flurbiprofen axetil while Group C received 100 mg tramadol. Postoperative pain was evaluated with the numerical rating scale (NRS) pain score. Remifentanil consumption, heart rate, and noninvasive blood pressure were recorded intraoperatively. Adverse events were documented. The primary outcome was analgesic effect according to NRS scores.
Results: NRS scores at rest were significantly lower in Group M than in Group C before discharge from the postoperative anesthetic care unit (P = 0.003) and at 2 (P = 0.008), 4 (P = 0.020), and 8 h (P = 0.016) postoperatively. Group M also had significantly lower NRS scores during coughing/swallowing at 5 min after extubation (P = 0.017), before discharge from the postoperative anesthetic care unit (P = 0.001), and at 2 (P = 0.002) and 4 h (P = 0.013)postoperatively. Compared with Group C, NRS scores were significantly lower throughout the first 24 h postoperatively in Group M at rest (P = 0.008) and during coughing/swallowing (P = 0.003). No serious adverse events were observed in either group.
Conclusion:Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provided better analgesia than tramadol after radical thyroidectomy.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙