丙泊酚与挥发性麻醉剂对心脏手术后持续性疼痛的影响：一项随机对照试验。

The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain After Cardiac Surgery: A Randomized Controlled Trial.

机构信息

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.

出版信息

J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2438-2446. doi: 10.1053/j.jvca.2020.10.025. Epub 2020 Oct 19.

DOI:10.1053/j.jvca.2020.10.025

PMID:33183935

Abstract

OBJECTIVES

Sternal incisions can generate persistent and intense post-sternotomy pain. Propofol has been shown to improve postoperative analgesia, but the preventive effect on persistent pain after cardiac surgery is unknown. The hypothesis of the present study was that intraoperative propofol-based anesthesia compared with volatile anesthesia could reduce the risk of chronic pain after cardiac surgery.

DESIGN

A single-center, two-arm, patient-and-evaluator-blinded, randomized controlled trial.

SETTING

A single major urban teaching and university hospital.

PATIENTS

Five-hundred adult patients undergoing cardiac surgery via sternotomy randomly were assigned. With six withdrawals from the study and five from surgery, 244 in the total intravenous anesthesia group and 245 in the volatile group were included in the modified intention-to-treat analysis.

INTERVENTIONS

Patients randomly were assigned to receive either propofol-based total intravenous anesthesia or volatile anesthesia during surgery.

MEASUREMENTS AND MAIN RESULTS

The primary outcomes were the incidence of pain at three, six, and 12 months after surgery defined as pain score >0 on the numeric rating scale. The secondary outcomes included acute pain, opioid use during the first 72 hours after surgery, and quality of life. The use of propofol did not significantly affect chronic pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%, difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v 20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with volatile anesthetics. Furthermore, there were no differences in acute pain score; morphine-equivalent consumption during the first 72 hours; and quality of life at three, six, and 12 months after surgery.

CONCLUSIONS

Intraoperative administration of propofol did not reduce persistent pain after cardiac surgery compared with volatile anesthetics.

摘要

目的

胸骨切开术可引起持久且剧烈的胸骨后疼痛。已有研究表明，丙泊酚可改善术后镇痛效果，但它对心脏手术后持续性疼痛的预防作用尚不清楚。本研究假设与挥发性麻醉相比，心脏手术期间使用丙泊酚为基础的麻醉可降低心脏手术后慢性疼痛的风险。

设计

单中心、两臂、患者和评估者设盲、随机对照试验。

地点

一家主要的城市教学和大学医院。

患者

500 名接受胸骨切开术的成年心脏手术患者被随机分配。由于研究中有 6 人退出，手术中有 5 人退出，244 人纳入全静脉麻醉组，245 人纳入挥发性麻醉组，进行意向治疗分析。

干预

患者随机接受丙泊酚为基础的全静脉麻醉或手术期间的挥发性麻醉。

测量和主要结果

主要结局是术后 3、6 和 12 个月时疼痛的发生率，定义为数字评分量表上的疼痛评分>0。次要结局包括急性疼痛、术后 72 小时内阿片类药物的使用以及生活质量。与挥发性麻醉相比，使用丙泊酚并未显著影响术后 3 个月（55.4%比 52.9%，差异 2.5%，95%置信区间[CI]为-6.6 至 11.6；p=0.656）、6 个月（35.5%比 37.5%，差异-2.0%，95%CI-10.9 至 6.9；p=0.657）或 12 个月（18.2%比 20.7%，差异-2.5%，95%CI-9.8 至 4.8；p=0.495）的慢性疼痛。此外，在急性疼痛评分、术后 72 小时内吗啡等效消耗量以及术后 3、6 和 12 个月的生活质量方面也没有差异。