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关节镜下颞下颌关节手术患者术中非阿片类麻醉的随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游霄 编辑：田明德 审校：曹莹
背景：颞下颌关节 (TMJ) 手术后的疼痛强度常常被低估，疼痛控制不足可能与恢复质量差、阿片类药物消耗量增加和住院时间延长有关。该试验旨在评估非阿片类麻醉是否为接受颞下颌关节手术的患者提供了一种有前景的疼痛管理选择。
方法：60 名接受颞下颌关节手术的患者被随机分为对照组和非阿片组。非阿片麻醉使用利多卡因、右美托咪定和氯胺酮输注治疗来控制疼痛。主要结局是在麻醉后护理室 (PACU) 期间记录的最高疼痛评分。次要结局包括围手术期阿片类药物的消耗、使用、剂量和 PACU 中抢救镇痛的时间、术后 PACU 和家中恶心和呕吐的发生率、疼痛满意度、阿片类药物相关不良反应的发生情况、PACU 和住院时间 术后 24 小时和 48 小时的住院时间以及羟考酮-对乙酰氨基酚片剂的总消耗量。
结果：患者主要为女性 (88.3%)，中位年龄为 37.5 [IQR 26.0, 52.5] 岁。在记录的最高疼痛评分（平均差 [MD] -0.36 分，95% CI：-1.84, 1.12，p = 0.63）、术后羟考酮-对乙酰氨基酚消耗量（MD 6.68 mg，95% CI： −2.48, 15.84, p = 0.15)，疼痛满意度（比值比 [OR] 0.81， 95% CI：0.23, 2.81，p = 0.74），PACU 出院时间（风险比 [HR] 1.24，95% CI：0.67, 2.30，p = 0.49）或出院时间（HR 1.48，95% CI： 0.80, 2.75, p = 0.21) 两组之间。同样，从手术结束后的分钟数计算，救援镇痛时间也没有观察到显着差异（HR 1.69，95% CI：0.79、3.61，p = 0.18）。
结论：在接受关节镜下颞下颌关节手术的患者中，与阿片类药物麻醉相比，非阿片类麻醉用于疼痛管理显示出相似的术后镇痛效果。
原始文献：Ma, H., Perez, J., Bertsch, J., Albanese, M., Korn, E., Mueller, A., Houle, T., Burris, B., McCain, J., & Wang, J. (2024). Intraoperative Non-Opiate Anesthesia for Patients Undergoing Arthroscopic Temporomandibular Joint Surgery: A Randomized Controlled Trial. Drug Design Development and Therapy, Volume 18, 4915–4925.
Intraoperative Non-Opiate Anesthesia for Patients Undergoing Arthroscopic Temporomandibular Joint Surgery: A Randomized Controlled Trial
Background: Pain intensity after temporomandibular joint (TMJ) surgery is often underestimated, and inadequate pain control may relate to poor recovery quality, increased opioid consumption, and longer hospital stay. This trial aims to evaluate whether non-opiate anesthesia provides a promising option of pain management for patients undergoing TMJ surgery.
Methods: Sixty patients receiving TMJ surgery were randomly assigned to either the control group or the non-opiate group. Nonopiate anesthesia used lidocaine, dexmedetomidine, and ketamine infusion therapy for pain management. The primary outcome was the highest documented pain score while in the post-anesthesia care unit (PACU). Secondary outcomes included perioperative opioid consumption, utilization, dosage, and timing of rescue analgesia in the PACU, incidence of postoperative nausea and vomiting in the PACU and at home, pain satisfaction levels, occurrence of opioid-related adverse effects, duration of PACU and hospital stays, and total consumption of oxycodone-acetaminophen tablets at 24 and 48 hours post-surgery.
Results: Patients were predominantly female (88.3%) and had a median age of 37.5 [IQR 26.0, 52.5] years. There were no significant differences observed in the highest documented pain scores (mean difference [MD] −0.36 points, 95% CI: −1.84, 1.12, p = 0.63), postoperative oxycodone-acetaminophen consumption (MD 6.68 mg, 95% CI: −2.48, 15.84, p = 0.15), pain satisfaction (odds ratio [OR] 0.81, 95% CI: 0.23, 2.81, p = 0.74), time to PACU discharge (hazard ratio [HR] 1.24, 95% CI: 0.67, 2.30, p = 0.49) or time to hospital discharge (HR 1.48, 95% CI: 0.80, 2.75, p = 0.21) between the two groups. Similarly, no significant difference was observed in time to rescue analgesia, calculated in minutes from the end of surgery (HR 1.69, 95% CI: 0.79, 3.61, p = 0.18).
Conclusion: Non-opiate anesthesia for pain management shows a similar postoperative analgesia effect, compared to opioid-based anesthesia, in patients undergoing arthroscopic TMJ surgery.
