唤醒麻醉技术降低开颅患者术后急性疼痛:一项回顾性研究

Intraoperative awake anesthesia improves acute postoperative analgesia in patients undergoing craniotomy:A retrospective study

目的观察唤醒麻醉技术对开颅手术患者术后疼痛的影响。方法回顾性连续收集2018年10月—2019年6月在首都医科大学附属北京天坛医院行术中唤醒颅内肿瘤切除术患者(唤醒组),根据年龄、性别、手术入路及手术时间按照1∶1比例匹配全身麻醉行颅内肿瘤切除术患者(对照组)。通过住院病历系统采集两组患者资料,电话随访患者术后3个月的疼痛(慢性疼痛)情况。主要指标为患者术后在PACU、住院期间急性疼痛情况以及术后慢性疼痛发生情况。结果本研究最终纳入80例患者,其中唤醒组40例,对照组40例。唤醒组患者PACU期间及住院期间急性疼痛发生率低于对照组(50.0%比75.0%,P=0.021;50.0%比72.5%,P=0.039),术后慢性疼痛发生率两组间差异无统计学意义(P>0.05)。唤醒组在PACU期间中重度疼痛[疼痛数字评分法(Numeric Rating Scales,NRS)评分≥4分]比例小于对照组(7.5%比27.5%,P=0.019),住院期间中重度急性疼痛的比例两组间差异无统计学意义(P>0.05),术后中度以上慢性疼痛的比较差异无统计学意义(P>0.05)。结论唤醒麻醉技术中以充分头皮神经阻滞为主的多模式镇痛能够显著缓解开颅术后急性疼痛,但是对于慢性疼痛的影响还需要进一步研究。

Objective To observe the effects of intraoperative awake anesthesia on the postoperative pain in patients undergoing craniotomy.Methods Patients undergoing intracranial tumor resection under asleep‑awake‑asleep protocol from October 2018 to June 2019 in Beijing Tiantan Hospital,Capital Medical University were consecutively selected and set as an awake group.Meanwhile,those undergoing intracranial tumor resection under general anesthesia were selected in which age,sex,surgical approach and surgery time were matched at a ratio of 1∶1 and set as a control group.The data of the two groups were collected from medical records,and their chronic pain 3 months after operation was followed up by telephone.The main outcomes were postoperative acute pain in postanesthesia care unit(PACU)and during hospitalization stay and postoperative chronic pain.Results A total of 80 patients were finally enrolled,including 40 patients in the awake group and 40 patients in the control group.The incidence of acute pain in PACU and during hospitalization stay in the awake group were significantly lower than that in the control group(50.0%vs 75.0%,P=0.021;50.0%vs 72.5%,P=0.039),but there was no statistical difference in chronic pain incidence between the two groups after operation(P>0.05).The percentage of patients with a Numerical Rating Scale(NRS)score≥4 points(moderate and severe pain)in the awake group in PACU was also significantly less than that in the control group(7.5%vs 27.5%,P=0.019).There was no significant difference between the two groups in the percentage of moderate to severe acute pain during hospitalization stay(P>0.05),and there was no significant difference in moderate to severe chronic pain after operation(P>0.05).Conclusions For awake anesthesia,the multi‑module analgesia based on adequate scalp nerve block can remarkably relieve acute pain after craniotomy,but further study is still needed to investigate its impact on chronic pain.