【罂粟摘要】腹腔镜手术中使用咖啡因对其术后阿片类药物消耗量及相关结局的影响：一项随机对照试验
腹腔镜手术中使用咖啡因对其术后阿片类药物消耗量及相关结局的影响：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：潘志军 编辑：佟睿 审校：曹莹
手术患者易受阿片类药物依赖及其相关风险的影响。临床转化数据表明咖啡因可以改善术后镇痛。这项试验检验了术中使用咖啡因能够减少术后阿片类药物消耗的假设。次要目标是评估咖啡因是否促进患者术后神经心理恢复。
这是一项单中心、随机、安慰剂对照试验。患者、临床医生、研究团队和数据分析员均不知道干预措施。在手术期间，我们将65例择期行腹腔镜结直肠和胃肠手术的成年(≥18岁)患者随机分配到静脉注射枸橼酸咖啡因(200mg)组或5%葡萄糖水溶液(40mL)组。主要结局指标是术后第3天阿片类药物的累积消耗量。次要结局指标包括主观疼痛报告、观察者的疼痛报告、谵妄、连线测验表现、抑郁和焦虑筛查以及情感评分。同样报告了不良事件，并比较了两组之间的血流动力学特征。
本研究最终共检验了60名患者，即每组随机从中抽取30名患者。咖啡因组患者累积阿片类药物消耗量(口服吗啡当量，mg)的中位数(四分位数间距)为77mg(33~182mg)，安慰剂组为51mg(15~117mg)(估计差异为55mg；95%置信区间[CI]，-9~118；P=0.092)。对基线不平进行校正后，咖啡因与阿片类药物消耗量增加有关(87mg；95%置信区间，26~148；P=0.005)。除此之外，各组之间在预先指定的疼痛或神经心理学结果方面没有差异。未报告与咖啡因相关的重大不良事件，也未观察到服用咖啡因后出现重大血流动力学紊乱。
咖啡因似乎不太可能减少术后早期阿片类药物的消耗。其次，咖啡因对麻醉苏醒时间几乎没有影响。
Phillip E. Vlisides, Duan Li, Amy McKinney, et al. The Effects of Intraoperative Caffeine on Postoperative Opioid Consumption and Related Outcomes After Laparoscopic Surgery: A Randomized Controlled Trial[J]. (Anesth Analg 2021 07 01;133(1)).
The Effects of Intraoperative Caffeine on Postoperative Opioid Consumption and Related Outcomes After Laparoscopic Surgery: A Randomized Controlled Trial
Abstract
Background: Surgical patients are vulnerable to opioid dependency and related risks. Clinical-translational data suggest that caffeine may enhance postoperative analgesia. This trial tested the hypothesis that intraoperative caffeine would reduce postoperative opioid consumption. The secondary objective was to assess whether caffeine improves neuropsychological recovery postoperatively.
Methods: This was a single-center, randomized, placebo-controlled trial. Participants, clinicians, research teams, and data analysts were all blinded to the intervention. Adult (≥18 years old) surgical patients (n=65) presenting for laparoscopic colorectal and gastrointestinal surgery were randomized to an intravenous caffeine citrate infusion (200 mg) or dextrose 5% in water (40 mL) during surgical closure. The primary outcome was cumulative opioid consumption through postoperative day 3. Secondary outcomes included subjective pain reporting, observer-reported pain, delirium, Trail Making Test performance, depression and anxiety screens, and affect scores. Adverse events were reported, and hemodynamic profiles were also compared between the groups.
Results: Sixty patients were included in the final analysis, with 30 randomized to each group. The median (interquartile range) cumulative opioid consumption (oral morphine equivalents, milligrams) was 77 mg (33–182 mg) for caffeine and 51 mg (15–117 mg) for placebo (estimated difference, 55 mg; 95% confidence interval [CI], −9 to 118; P =0.092). After post hoc adjustment for baseline imbalances, caffeine was associated with increased opioid consumption (87 mg; 95% CI, 26–148; P =0.005). There were otherwise no differences in prespecified pain or neuropsychological outcomes between the groups. No major adverse events were reported in relation to caffeine, and no major hemodynamic perturbations were observed with caffeine administration.
Conclusions: Caffeine appears unlikely to reduce early postoperative opioid consumption. Caffeine otherwise appears well tolerated during anesthetic emergence.