减肥手术中无阿片类药物麻醉：一项前瞻性随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游霄 编辑：赵游霄 审校：曹莹
背景：减肥手术越来越多地用于治疗肥胖症，这带来了显著的围手术期挑战，尤其是阿片类药物的使用。无阿片麻醉（OFA）是一种多模式技术，旨在解决这些问题。本研究旨在比较无阿片麻醉（OFA）与传统阿片类药物麻醉（OBA）在减肥手术后吗啡用量、血流动力学、疼痛、术后恶心呕吐（PONV）、镇静程度和患者满意度方面的效果。
方法：在一所三级医院的手术室进行了一项前瞻性对照研究。研究对象为年龄在 18 至 65 岁之间接受减肥手术的患者。58 名肥胖患者被分为两组：32 名接受 OBA，26 名接受 OFA。OFA 方案包括利多卡因、氯胺酮、硫酸镁、右美托咪定和地塞米松。主要结局指标包括术后麻醉恢复室（PACU）内、术后 24 小时和 48 小时的吗啡用量。次要结局指标包括术后 48 小时或出院前的血流动力学参数、镇静评分、疼痛评分、恶心和/或呕吐的发生情况以及患者总体满意度。
结果：OFA 显著减少了术后吗啡用量（中位剂量为 8 毫克对 19 毫克，p = 0.000）。OFA 组在静息、活动和咳嗽时的视觉模拟评分（VAS）疼痛评分显著更低。两组患者围手术期血流动力学均稳定。术后恢复室（PACU）、术后 24 小时和 48 小时，两组患者术后恶心呕吐（PONV）发生率和镇静水平无显著差异。OFA 组患者满意度更高，65%的患者满意度评分≥8/10，而 OBA 组为 28%。
结论：OFA 可减少术后吗啡用量，改善疼痛管理，且不损害血流动力学稳定性和增加镇静水平。此外，PONV 发生率无显著差异，且总体患者满意度更高。这些发现支持在减肥手术中使用 OFA，尽管仍需更大样本量的研究进一步证实。
原始文献：
Dagher C, Mattar R, Aoun M, et al. Opioid-free anesthesia in bariatric surgery: a prospective randomized controlled trial. [J]. European journal of medical research, 2025, 30(1).
Opioid-free anesthesia in bariatric surgery: a prospective randomized controlled trial
Abstract
Background Bariatric surgeries are increasingly used to manage obesity, presenting significant perioperative challenges, especially with opioid use. Opioid-Free Anesthesia (OFA) is a multimodal technique to address these issues. This study aims to compare the effects of OFA and traditional Opioid-Based Anesthesia (OBA) on postoperative morphine consumption, hemodynamics, pain, postoperative nausea and vomiting (PONV), sedation, and patient satisfaction in bariatric surgery.
Methods A prospective controlled study was conducted in the operating room of a tertiary university hospital. It included patients aged between 18 and 65 years undergoing bariatric surgery. 58 obese patients were divided into two groups: 32 received OBA and 26 received OFA. The OFA regimen included lidocaine, ketamine, magnesium sulfate, dexmedetomidine, and dexamethasone. Main outcome measures included postoperative morphine consumption in the Post-Anesthesia Care Unit (PACU), 24 and 48 h after surgery. Secondary outcomes included hemodynamic parameters, sedation score, pain score, presence of nausea and/or vomiting, and overall patient satisfaction evaluated at 48 h postoperatively or before hospital discharge were recorded.
Results OFA significantly reduced postoperative morphine consumption (median dose of 8 mg vs.19 mg, p = 0.000). Visual analogue scale (VAS) scores for pain at rest, during movement, and during coughing were significantly lower in the OFA group. Both groups were hemodynamically stable perioperatively. There was no significant difference in PONV incidence or sedation levels between the groups in the PACU, 24 and 48 h after surgery. Patient satisfaction was higher in the OFA group, with 65% reporting a satisfaction score of ≥ 8/10 compared to 28% in the OBA group.
Conclusions OFA reduces postoperative morphine consumption and improves pain management without compromising hemodynamic stability or increasing sedation. Furthermore, the incidence of PONV was not significantly different and overall patient satisfaction was higher with OFA. These findings support the use of OFA in bariatric surgery, despite the need for further studies with larger sample sizes.