Clinical Effect of Different Drugs and Infusion Techniques for Patient-controlled Analgesia After Spinal Tumor Surgery: A Prospective,Randomized, Controlled Clinical Trial |
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| Institution: | 1. Children''s Minnesota, Minneapolis, Minnesota;2. Ann & Robert H. Lurie Children''s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Children''s Mercy Kansas City, Missouri;1. Massachusetts General Hospital and MGH Weight Center, Boston, MA;2. Mother Infant Research Institute at Tufts Medical Center, Boston, MA;1. Service de Médecine Intensive Réanimation, CHU Bordeaux, Bordeaux, France;2. Service de Réanimation Médicale, CHU Grenoble Alpes, La Tronche, France;3. Service Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France;4. Service Médecine Intensive Réanimation, Hôpital Saint-Louis (APHP), Paris, France;5. Service d''Anesthésie et Réanimation Médicale et Chirurgicale, Centre Hospitalier Lyon Sud, Lyon, France;6. Service de Néphrologie, CHU Bordeaux, Bordeaux, France;7. Service de Médecine Intensive Réanimation, CHU Gabriel-Montpied, Clermont-Ferrand, France;1. Geriatric Research Education and Clinical Center, James J Peters VA Medical Center, Bronx NY USA;2. Icahn School of Medicine at Mount Sinai, New York, NY USA;1. Geriatric Research, Education, and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts;2. Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts;3. Puget Sound Veterans Affairs Medical Center, Seattle, Washington;4. Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas;5. University of Arkansas for Medical Sciences, Little Rock, Arkansas;6. Boise Veterans Affairs Medical Center, Boise, Idaho;7. The Department of Biomedical Sciences, Tufts University School of Medicine, Medford, Massachusetts;8. The Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington;1. Service de Médecine Intensive Réanimation, CHU Bordeaux, Bordeaux, France;2. Service de Réanimation Médicale, CHU Grenoble Alpes, La Tronche, France;3. Service Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France;4. Service Médecine Intensive Réanimation, Hôpital Saint-Louis (APHP), Paris, France;5. Service d''Anesthésie et Réanimation Médicale et Chirurgicale, Centre Hospitalier Lyon Sud, Lyon, France;6. Service de Néphrologie, CHU Bordeaux, Bordeaux, France;7. Service de Médecine Intensive Réanimation, CHU Gabriel-Montpied, Clermont-Ferrand, France |
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| Abstract: | PurposeTo evaluate the outcomes of the different drug combination and infusion techniques for patient-controlled analgesia (PCA).MethodsNinety-seven patients who had undergone spinal tumor surgery were randomized to 4 groups with different PCA drugs and infusion techniques: subcutaneous sufentanil (SS) group; (n=25), subcutaneous sufentanil and dexmedetomidine (SDS) group (n=24), intravenous sufentanil (SI) group (n=23), and intravenous sufentanil and dexmedetomidine (SDI) group (n=25). The primary outcome measured the cumulative amount of sufentanil delivered to the patients through PCA 24 and 48 hours after the surgery. Secondary outcomes measured the visual analog scale pain scores 24 and 48 hours after the surgery, Pittsburgh Sleep Quality Index before and 1 month after surgery, Athens Insomnia Score before and the first 2 nights after surgery, and the rate of adverse events within 48 hours after surgery.FindingsAt 24 and 48 hours after surgery, the cumulative amount of sufentanil in the SDS group (mean SD], 76.44 10.75] at 24 hours and 151.96 20.92] at 48 hours) and the SDI group (mean SD], 75.08 9.00] at 24 hours and 149.56 18.22] at 48 hours) were significantly lower than in SS group (mean SD] 95.52 12.40] at 24 hours and 183.23 23.06] at 48 hours) and the SI group (mean SD], 97.25 10.80] at 24 hours and 186.67 20.14] at 48 hours; P < 0.001). The visual analog scale pain scores and Athens Insomnia Scale scores were also lower in the SDS and SDI groups than in the SS and SI groups 24 and 48 hours after surgery (P < 0.05). The Pittsburgh Sleep Quality Index was lower in the SDS and SDI groups 1 month after surgery. Lastly, the rate of nausea and vomiting was higher in the SI group than in the SS, SDS, and SDI groups (P = 0.018).ImplicationsDexmedetomidine in PCA could decrease sufentanil intake and improve analgesic effect and sleep quality. Subcutaneous PCA can provide the same benefit with a lower rate of nausea and vomiting. ClinicalTrials.gov identifier: NCT04111328. |
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