The goal of this study is to elucidate the efficacy and safety of oxelidine combined with oligopiate anesthesia for multi-modal analgesia in weight-loss surgery in morbidly obese patients, and to discover a new strategy for multi-modal analgesia management in weight-loss surgery, laying a foundation for the widespread application of oligopiate anesthesia in special patients.
A total of 124 patients who underwent elective bariatric surgery in our hospital were selected, and the participants were randomly divided into two groups: the opioid anesthesia group (OBA group) and the low-opioid anesthesia group (OFA group) using a random number table to achieve simple randomization.
Inclusion criteria: 1.ASA grade I \~ III; 2. Age ≥18 years old; 3. Bariatric surgery patients with BMI≥35kg/m2 and complex signs of morbid obesity (such as metabolic syndrome) 4. Sign the informed consent form.
Exclusion criteria: 1. Positive pregnancy test or breastfeeding; 2. Patients with a history of substance abuse or dependence on opioids; 3. Patients with chronic pain or with severe heart, lung, liver or nervous system diseases.
Anesthesia implementation: 1. Routine monitoring after entry, intravenous administration of midazolam and atropine. Study participants were placed in the ramp position, bilateral recurrent laryngeal nerve block under ultrasound guidance, and the mouth contained dachronine gel. Radial artery puncture was performed and dexmedetomidine was injected intravenously. A laryngeal tube is used to test the sensation of the back of the oropharynx, and a laryngeal mask is placed while awake to connect the anesthesia circuit and deliver oxygen. Once the vocal cords are seen and the end-respiratory CO2 waveform is observed.
2\. The OBA group underwent combined anesthesia induction with propofol, rocuronium bromide and sufentanil, endotracheal intubation through visual laryngeal mask, intraoperative pump injection of propofol and remifentanil to maintain anesthesia, sufentanil bridging 10μg 30 minutes before the end of the operation; In OFA group, propofol, rocuronium bromide and esketamine were induced by combined anesthesia, and endotracheal intubation was performed through visual laryngeal mask. Intraoperative pump propofol and esketamine to maintain anesthesia; Oxeridine was bridged-1.5 mg 30min before the operation and administered in two doses, 0.75mg/ time, with an interval of 10min.
3\. Both groups were subjected to bilateral lower costal margin transversal nerve block under ultrasound guidance.
4\. Ondansetron was given before the end of the operation. After the operation, the tracheal cannula was removed under deep anesthesia, and the laryngeal mask was retained and transferred to the postoperative resuscitation room. Sugengosaccharide sodium was used to antagonize muscle pine during recovery. After the study participants were awake, the laryngeal mask was well tolerated. The laryngeal mask was removed after observation for 1h, and the laryngeal mask was safely transferred to the ward after continuous observation for 1h.
PCA administration regimen in OBA group: Sufentanil + dexmedetomidine + Ondansetron; OFA group PCA administration regimen: oxelidine + dexmedetomidine + Ondansetron. Record the number of compressions, if the assessment of NRS≥4 points, then remedy 2mg oxycodone hydrochloride, and record the dosage.
Main outcome measures: Consumption of oral morphine equivalent (OME) opioids in the 24 hours prior to surgery.
Secondary outcome measures: Overall satisfaction with analgesia and Numerical Rating Scale (NRS, 0-10) pain score, area under the curve of resting and exercise NRS score (AUC) within 72 hours after surgery, time to first use of rescue analgesics within 72 hours, cumulative opioid consumption 72 hours after surgery (morphine milligram equivalent, morphine milligram equivalent, NRS score) MME), participants' satisfaction with postoperative analgesia, 15-item Quality of Recovery score Scale (QoR15) at 24, 48, and 72h after surgery, incidence of postoperative complications, incidence of nausea and vomiting, and incidence of adverse events were recorded.
Patients undergoing weight loss surgery under general anesthesia;
Age ≥18 years old;
American Society of Anesthesiologists ASA Grade I-III;
BMI≥35kg/m2 with complex signs of morbid obesity (such as metabolic syndrome)
Pregnancy test positive or breastfeeding;
Patients with a history of substance abuse or dependence on opioids;
Patients with chronic pain or with severe heart, lung, liver or nervous system diseases.
Parallel
oxalidine
DrugOpioid anesthesia group (OBA group) Anesthesia was induced with propofol 2.5mg·kg-1, rocuronium 0.6mg·kg-1 and sufentanil 0.3μg·kg-1. When BIS value reached 40-60, tracheal intubation was performed through visual laryngeal mask airway. Anesthesia was maintained with propofol 4-12 mg·kg-1·h-1 and remifentanil 0.2-0.5 μg·kg-1·min-1. Sufentanil 10μg was bridaged 30min before the end of surgery. The PCA dosing regimen was sufentanil 2 µg/kg+ dexmedetomidine 2 µg/kg+ ondansetron 24mg. Reduced-opioid anesthesia group (OFA group) Anesthesia was induced with propofol 2.5mg·kg-1, rocuronium 0.6mg·kg-1 and esketamine 0.3mg·kg-1. When BIS value reached 40-60, tracheal intubation was performed through visual laryngeal mask airway. Propofol 4-12 mg·kg-1·h-1 and esketamine 0.3-0.5 mg·kg-1·h-1 were pumped to maintain anesthesia during operation. Oxalidine 1.5mg was given in two divided doses of 0.75mg each time with an interval of 10min 30min before the end of surgery. The PCA regimen was as follows:
Oral morphine equivalent (OME) opioid consumption in the 24 hours prior to surgery
Area under the NRS score curve at rest and exercise 72 hours after surgery (AUC)
Area under the NRS score curve at rest and exercise 72 hours after surgery (AUC)
Overall satisfaction with analgesia and Numerical Rating Scale (NRS, 0-10) pain scores, study participants' satisfaction with postoperative analgesia, 15-item Quality of Recovery score Scale (QoR15) at 24, 48, and 72h after surgery
Numeric Rating Scale (NRS) pain score was used to evaluate the degree of pain. According to the degree of self-rating on a 10-point scale, a total of 1-10 points, according to the corresponding numbers can be divided into different degrees of pain, that is, 0 is no pain, 1 to 3 is mild pain, 4 to 6 is moderate pain, 7 to 10 is severe pain. study participants' satisfaction with postoperative analgesia, The QoR-15 scale, which ranges from 0 (very poor quality of recovery) to 150 (excellent quality of recovery), can visually reflect the postoperative recovery status of patients. In addition, the scale has high reliability and validity, and the assessment time is relatively short, usually 3-4 minutes, which facilitates its wide application in clinical practice.
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Yongtao Sun
Lead sponsor
Qianfoshan Hospital
Sponsor institution
The First Hospital affiliated of Shandong First Medical University
Collaborator
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