麻醉相关效应：丙泊酚麻醉患者的手术后疼痛轻于异氟烷麻醉患者  

作　　者：Sean S. Cheng, MS Janet Yeh, BS Pamela Flood, MD 浦少峰(译) 

机构地区：[1]Department of Anesthesiology, Columbia University, New York City, New York [2]不详

出　　处：《麻醉与镇痛》2009年第2期56-62,共7页Anesthesia & Analgesia

摘　　要：背景临床前期实验显示某些挥发性麻醉药可能通过抑制烟碱受体引起痛觉过敏。早期的实验证实，给予异氟烷麻醉的女性患者鼻腔内喷雾烟碱，具有手术后镇痛作用。为了确定烟碱是逆转了异氟烷引起的痛觉过敏，还是单纯充当了镇痛药的角色，本研究探讨了烟碱对异氟烷＋芬太尼或丙泊酚＋芬太尼麻醉的女性患者手术后疼痛的影响。方法此项随机、前瞻、双盲研究，对80例采用异氟烷或丙泊酚麻醉行开腹子宫手术的女性患者加以研究。在2个麻醉组中，受试者又被随机分为烟碱3mg组或安慰剂组。数字模拟疼痛评分是首要的观察指标。结果患者的基本情况相似。丙泊酚麻醉组手术后第1天的疼痛评分及吗啡用量要小于异氟烷麻醉组（P〈0．01，P〈0．01）。烟碱的使用没有改变任一组的疼痛评分及吗啡用量（P〉0．05）。结论采用丙泊酚行全身麻醉的患者手术后疼痛及吗啡用量要小于异氟烷麻醉的患者。本研究中烟碱不具有镇痛作用。若上述结果在其他人群中具有可重复性，那么丙泊酚麻醉除具有以前报道的改善恶心、呕吐外的潜在优势外，还能减轻手术后疼痛。BACKGROUND： Preclinical studies have suggested that some volatile anesthetics induce a hyperalgesic state that may be secondary to nicotinic inhibition. A previous trial of treatment with nicotine nasal spray demonstrated postoperative analgesia in women anesthetized with isoflurane. To determine whether the effect of nicotine was reversing hyperalgesia induced by isoflurane, or simply acting as an analgesic, we studied the effect of nicotine on postoperative pain in women anesthetized with isoflurane or propofol, with fentanyl. METHODS： In a randomized, prospective, double-blind trial, we assigned 80 women having open uterine surgery to be anesthetized with isoflurane or propofol. Within each anesthetic group, the subjects were further randomly assigned to receive nicotine 3 mg or placebo. Pain reported with a numerical analog scale was the primary outcome variable. RESULTS： The patient demographics were similar. Women who were anesthetized with propofol reported less pain and used less morphine during the first day after surgery than women who were anesthetized with isoflurane （P 〈 0. 01, P 〈 0. 01 ）. Nicotine treatment did not change pain report or morphine use in either anesthetic group （P 〉 0.05 ）. CONCLUSIONS： General anesthesia with propofol and is associated with less postoperative pain and morphine use than general anesthesia with isoflurane. Nicotine was not analgesic in this trial. If these results are repeated in other populations, reduced postoperative pain can be added to the previously described improvement in nausea and vomiting as a potential benefit of anesthesia with propofol.

关 键 词：手术后疼痛 氟烷麻醉 丙泊酚 术后镇痛作用 烟碱受体 挥发性麻醉药 女性患者 疼痛评分 

分 类 号：R619[医药卫生—外科学] R782.21[医药卫生—临床医学]