妇科手术中加巴喷丁用于术后镇痛的半数有效剂量

ED_(50) of gabapentin for postoperative analgesia in patients undergoing gynecological operation

目的研究加巴喷丁用于妇科腹腔镜手术及开腹手术术后镇痛的半数有效剂量(ED_(50))。方法选择65例拟行妇科腹腔镜和开腹手术患者,年龄30~50岁,ASAⅠ~Ⅱ级。所有患者术前2 h口服加巴喷丁,根据Dixon序贯法确定给药剂量。腹腔镜手术中加巴喷丁的剂量从9.5 mg·kg^(-1)开始,开腹手术中加巴喷丁的剂量从10 mg·kg^(-1)开始,剂量等级为0.5mg·kg^(-1)。在全凭静脉麻醉下实施手术,若患者术后镇痛效果佳,VAS评分≤3分,认为加巴喷丁的镇痛剂量是足够并有效,选择下一例患者时加巴喷丁浓度拟降低一个等级;若患者术后镇痛效果差,VAS评分>3分,认为加巴喷丁的镇痛剂量不够,选择下一例患者时加巴喷丁浓度拟升高一个等级。结果根据Dixon序贯法,结果显示妇科腹腔镜和开腹手术中加巴喷丁用于术后镇痛的ED_(50)值分别为8.5 mg·kg^(-1)(95%CI 8.3~8.7 mg·kg^(-1))和10.3 mg·kg^(-1)(95%CI 10.0~10.5 mg·kg^(-1))。结论加巴喷丁可有效用于妇科腹腔镜手术及开腹手术术后镇痛,ED_(50)与手术类型有关。

AIM To determine the medium effective dose（ED50） of gabapentin for postoperative analgesia in patients undergoing gynecological laparoscopic operation and transabdominal operation. METHODS Sixty-five patients aged 30- 50 years, with American society of anesthesiologists（ASA） physical status Ⅰ-Ⅱ , were scheduled for gynecological operationg All patients were given a certain dose of gabapentin 2 h before operation. An up-and-down sequential allocation technique was dose of gabapentin was 9 ation, and the changing employed to determine the dosage of gabapentin based on previous patients＇ responses The first 9.5 mg·kg- 1 in gynecological laparoscopic operation and 10mg·kg- 1 in gynecological open operscale was 0.5 mg·kg-1. All patients accepted total intravenous anesthesia. Pain was assessed using postoperative visual analog scale （VAS） in postanesthesia care unit. When a patient＇s responses to gabapentin showed effectiveness in postoperative analgesia （VAS score ≤ 3）, this dose of given gabapentin was considered as an effective one; then next patient would accept a decreased dose of gabapentin. In contrast, ineffective （VAS score 〉 3）, an increased dose of gabapentin would be of gabapentin for postoperative analgesia in patients undergoing gynecol given to the next when a patient＇s responses were patient RESULTS The ED50 ogical laparoscopic operation and open operation was 8.5 mg·kg-l（95%CI, 8.3 - 8.7 mg·kg-1） and 10.3 mg·kg-l（95%CI 10.0 - 10.5 mg·kg-1） respectively. CONCLUSION Gabapentin shows effective analgesia in patients undergoing gynecological laparoscopic operation and transabdominal operation, and ED50 relates to the kinds of operation.