术中静脉注射利多卡因对减肥手术后阿片类药物使用的影响：一项前瞻性、随机、盲法、安慰剂对照研究
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
由于肥胖患者存在不同的生理学和药理学风险，围手术期利多卡因输注量值得在减肥手术中进行研究。本项单中心、前瞻性、随机、双盲、安慰剂对照研究招募了计划接受采用增强康复方案的腹腔镜下减肥手术的肥胖患者。患者接受利多卡因(负荷量给予1.5 mg·kg-1，然后持续输注2 mg·kg-1·h-1至手术结束，然后在术后恢复室注射1 mg·kg-1·h-1持续1h)或等体积、等量0.9%生理盐水。主要观察指标是在术后前3天等效羟考酮静脉注射量。次要观察指标是：术后疼痛；恶心和呕吐的发生率；肠功能恢复天数；在术后恢复室的时间和住院时间。我们测定了利多卡因的血药浓度。在招募的178名患者中，对176名患者的数据进行了分析。利多卡因组和生理盐水组等效的羟考酮静脉注射量的中位数(IQR[range])分别为3.3mg (0.0-6.0[0.0-14.5])和5.0mg (3.3-7.0[3.3-20.0]) (中位数差值(95%CI): 1.7mg(0.6-3.4mg); p=0.004)。两组在术后恢复室观察时间、术后疼痛、恶心呕吐、肠功能恢复天数、住院时间上无差异。手术结束时和输注结束后1h，利多卡因平均(标准差)血药浓度分别为2.44(0.70)µg·ml-1和1.77(0.51)µg·ml-1。在减肥手术中输注利多卡因与术后羟考酮用量在临床上并无差异。
Effect of intra-operative intravenous lidocaine on opioid consumption after bariatric surgery: a prospective, randomised, blinded, placebo-controlled study
Summary
Peri-operative lidocaine infusion warrants investigation in bariatric surgery because obese patients present different physiological and pharmacological risks. This single-centre, prospective, randomised double-blind placebo-controlled study enrolled obese patients scheduled for laparoscopic bariatric surgery using an enhanced recovery protocol. Patients received either lidocaine (bolus of 1.5 mg.kg-1, then a continuous infusion of 2 mg.kg-1.h-1 until the end of the surgery, then 1 mg.kg-1.h-1 for 1h in the recovery area) or identical volumes and rates of 0.9% saline. The primary outcome was the consumption of the equivalent of oxycodone consumption over the first 3 postoperative days. Secondary outcomes were: postoperative pain; incidence of nausea and vomiting; bowel function recovery; and lengths of stay in the recovery area and in hospital. Plasma concentrations of lidocaine were measured. On the 178 patients recruited, data were analysed from 176. The median (IQR [range]) equivalent intravenous oxycodone consumption was 3.3 mg (0.0–6.0 [0.0–14.5]) and 5.0 mg (3.3–7.0 [3.3–20.0]) in the lidocaine and saline groups, respectively (difference between medians (95%CI): 1.7 (0.6–3.4) mg; p = 0.004). Length of stay in the recovery area, postoperative pain, nausea and vomiting, day of recovery of bowel function, and length of stay in hospital were not different between groups. Mean (SD) lidocaine plasma concentrations were 2.44 (0.70) µg.ml-1 and 1.77 (0.51) µg.ml-1 at the end of surgery and 1 hour after the end of infusion, respectively. Lidocaine infusion during bariatric surgery resulted in a clinically non-relevant difference in postoperative oxycodone consumption.
翻译：佟睿
编辑：佟睿
审校：曹莹
贵州医科大学高鸿教授课题组
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