纳布啡和氟比洛芬酯对老年胃肠道开放手术患者腹横肌平面阻滞多模式镇痛疗效评价：随机，对照，双盲试验
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Efficacy of Nalbuphine with Flurbiprofen on Multimodal Analgesia with Transverse Abdominis Plane Block in Elderly Patients Undergoing Open Gastrointestinal Surgery:A Randomized, Controlled, Double-Blinded Trial
背景与目的
对比不同剂量的纳布啡与氟比洛芬酯，舒芬太尼与氟比洛芬酯用于多模式镇痛中对老年胃肠道手术并采用腹横肌平面阻滞（TAPB）患者的疗效。
方 法
在全身麻醉和TAPB下对158名老年患者行选择性开放式胃肠手术，根据术后静脉镇痛（PCIA）中纳布啡和氟比洛芬酯的剂量随机分为4组。术后6,12,24和48小时记录术后疼痛强度，PCIA有效按压次数和其它不良反应。
结 果
4组患者术后切口疼痛强度，有效按压次数以及术后恶心呕吐（PONV）的发生率相似，而L组的术后恶心呕吐（PONV）严重程度在第6,12和48小时与S组相比有所降低。手术后没有个体发生瘙痒，呼吸抑制或低血压。
结 论
低剂量的纳布啡（15μg·kg-1·ml-1）联合氟比洛芬对于接受选择性开放胃肠道手术和TAPB的老年患者，在术后镇痛效率和降低PONV严重程度方面更优越。该试验在NCT02984865注册。
原始文献摘要
Mao Y, Cao Y, Mei B, et al. Efficacy of Nalbuphine with Flurbiprofen on Multimodal Analgesia with Transverse Abdominis Plane Block in Elderly Patients Undergoing Open Gastrointestinal Surgery: A Randomized, Controlled, Double-Blinded Trial.[J]. Pain Research & Management, 2018, 2018(2):3637013.
Abstract:
Objective. To assess different doses of nalbuphine with flurbiprofen compared to sufentanil with flurbiprofen in multimodal analgesia efficacy for elderly patients undergoing gastrointestinal surgery with a transverse abdominis plane block (TAPB). Methods. 158 elderly patients scheduling for elective open gastrointestinal surgery under general anesthesia and TAPB were randomly assigned to four groups according to different doses of nalbuphine with flurbiprofen in postoperative intravenous analgesia (PCIA). Postoperative pain intensity, effective pressing numbers of PCIA, and adverse effects were recorded at 6, 12, 24, and 48 hours after surgery. Results. Postoperative pain intensity, effective pressing numbers, and the incidence of postoperative nausea and vomiting (PONV) were similar among the four groups after surgery, while the severity of PONV was decreased in Group L compared with Group S at 6, 12, and 48 h after surgery. No individual experienced pruritus, respiratory depression, or hypotension. Conclusions. Low dose of nalbuphine (15 μg·kg 1·ml 1) combined with flurbiprofen is superior for elderly patients undergoing elective open gastrointestinal surgery with TAPB in terms of the efficient postoperative analgesia and decreased severity of PONV. 0is trial is registered with NCT02984865.
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