术前肌注右美沙芬对全麻术后镇痛芬太尼用量的影响

The effect of preemptive use of dextromethorphan on fentanyl demand during postoperative analgesia

目的 观察术前应用右美沙芬 (dextromethorphan ,DM )对全麻术后镇痛芬太尼用量的影响。方法 选择 4 0例ASAⅠ～Ⅱ级 ,拟在全麻下行腰椎手术的患者 ,随机分为对照组及DM组 ,术前 30min分别肌注 4ml生理盐水或DM 2 0mg。术后应用芬太尼行静脉自控镇痛 (PCIA)。记录患者术后首次要求镇痛的时间 ,术后 1、2、4、2 4、4 8h的疼痛评分 (VAS) ,镇静评分 (OAA/S) ,芬太尼用量及术后恶心呕吐的情况。结果 从手术结束到患者首次要求镇痛的时间 ,DM组 (35 38±10 5 6 )min ,比对照组显著延长 [(12 80± 5 72 )min](P <0 0 1)。DM组术后 4 8h内芬太尼的总用量 (0 4 2± 0 10 )mg ,显著低于对照组 [(0 81± 0 0 9)mg](P <0 0 1)。术后恶心呕吐的发生率DM组与对照组分别为 10 %和 30 % (P <0 0 5 )。结论 全麻下施行腰椎手术 ,术前 30min肌肉注射DM2 0mg ,可为患者提供超前镇痛 ,延长术后第一次要求镇痛的时间 ,减少术后 4

Objective The effect of preoperative use of dextromethorphan(DM) on the fentanyl requirement during postoperative analgesia.Methods Forty adult patients of ASA grade Ⅰ-Ⅱ scheduled for vertebra surgery under general anesthesia were enrolled in this study.Patients were randomly divided into normal saline group(C)and DM group with 20 cases each.The patients in group DM were pre-medicated with DM 20 mg(4 ml) im 30 min before surgery,and those in group C with placebo(saline 4 ml).Postoperative patient-controlled intravenous analgesia(PCIA)with fentanyl started when subjective pain intensity(visual analog scale,VAS)was>4 cm.VAS and sedation status(OAA/S)were assessed at 1,2,4,24 and 48 h during postoperative period.Fentanyl consumption and complications during 48 h after operation were recorded.Results Fentanyl consumption was significantly lower in group DM(0.42±0.10) mg than that in group C(0.81±0.09) mg in 48 h PCIA(P<0.01).The mean time to initiation of PCIA was significantly longer in group DM(35.38±10.56) min than that in group C(12.80±5.72) min(P<0.01).The incidence of postoperative nausea and vomiting was significantly less in group DM(P<0.05).Conclusion Preemptive use of dextromethorphan 30 min before operation significantly reduces postoperative fentanyl consumption and incidence of nausea and vomiting in the patients given PCIA.