Effects of gabapentin and low-dose ketamine on remifentanil-induced hyperalgesia
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摘要: 目的 观察加巴喷丁联合小剂量氯胺酮对预防瑞芬太尼麻醉术后诱发痛觉过敏的作用。方法 选择行腹腔镜子宫切除术患者80例，随机平均分为4组：对照组（C组），加巴喷丁组（G组），氯胺酮组（K组），加巴喷丁-氯胺酮组（GK组）。观察4组患者术后第1 h、24 h痛觉过敏的发生率，术后30 min（T1）、1 h（T2）、2 h（T3）、4 h（T4）、8 h（T5）、24 h（T6）VAS评分，术后24 h内镇痛泵的按压次数，术后嗜睡、恶心呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生率。结果 与C组相比，GK组术后1 h痛觉过敏发生率明显降低（P<0.05）；G、K、GK组术后24 h内VAS评分、镇痛泵按压次数较C组明显降低，且GK组低于G组、K组（P<0.05）。G组、GK组术后24 h内恶心呕吐发生率低于C组、K组（P<0.05）。4组患者术后其他不良反应发生率的差异无统计学意义（P>0.05）。结论 加巴喷丁和小剂量氯胺酮联合使用可以有效缓解术后疼痛，减少术后镇痛药物用量，并且能够预防术后恶心呕吐的发生。Abstract: Objective To observe the effects of gabapentin and low-dose ketamine on the prevention of hyperalgesia induced by remifentanil anesthesia. Methods A total of 80 patients who underwent endoscopic hysterectomy under general anesthesia were randomly divided into four groups: a control group (Group C), a gabapentin group (Group G), a ketamine group (Group K), and a gabapentin + ketamine group (Group GK). The incidence of hyperalgesia of each group was observed 1 and 24 h after surgery. The scores of VAS were assessed 30 min (T1), 1 h (T2), 2 h (T3), 4 h (T4), 8 h (T5) and 24 h (T6) after surgery. The times of PICA usage and adverse reactions within 24 h after surgery were recorded. Results Compared with Group C, Group GK produced a remarkably lower incidence of hyperalgesia 1 h after surgery (P<0.05). The VAS scores and the times of PICA usage of Groups G, K and GK were significantly lower than that of Group C (P<0.05). Compared with Groups G and K, the VAS scores and the times of PICA usage were significantly decreased in Group GK (P<0.05). Groups G and GK reported lower incidences of nausea and vomiting within 24 h after surgery than Groups C and K (P<0.05). There was no significant difference among Groups C, G, K and GK in the incidence of other adverse reactions after surgery (P＞0.05). Conclusions The combined use of gabapentin and ketamine can effectively relieve post-operative hyperalgesia, reduce the dose of analgesics, and prevent postoperative nausea and vomiting.
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Keywords:
- gabapentin /
- low-dose ketamine /
- remifentanil /
- hyperalgesia
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