氯胺酮|延长围手术期应用普瑞巴林和氯胺酮时间可预防心脏手术后持续疼痛镇静|麻醉科|诊疗|配合度|超声

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【 氯胺酮|延长围手术期应用普瑞巴林和氯胺酮时间可预防心脏手术后持续疼痛】背景
心脏术后持续性疼痛比较常见，并且可影响生活质量。我们假设使用普瑞巴林和氯胺酮可以预防心脏手术后持续疼痛。
方法
这项随机、双盲、安慰剂对照试验是在英国的两个心脏外科中心进行。无慢性疼痛且正在接受任何择期心脏手术的成人患者，通过胸骨切开术后随机分配接受常规护理、普瑞巴林（术前150 mg，术后14天每天两次）治疗，或普瑞巴林联合术后48小时静脉输注氯胺酮0.1mg/kg/h.主要评估术后3个月和6个月临床显著疼痛的发生率，定义为在对三次最大咳嗽进行功能评估后，数字评分量表上的疼痛评分为4分或更高（满分10分）。次要结果包括急性疼痛、阿片类药物使用和安全措施，以及长期神经病理性疼痛、镇痛需求和生活质量。
结果
总共纳入150名患者进行随机分组，其中17名患者退出治疗，2名患者失去随访，但对所有参与者的数据进行了意向性治疗分析。与对照组（34%[50人中有17人]）疼痛发生率相比，单独使用普瑞巴林（6%[3/50]）和联合使用氯胺酮的患者（2%[1/50]）术后3个月的疼痛发生率均较低；其比值比分别为0.126[0.022-0.5]，P=0.0008；0.041[0.0009-0.28]，P<0.0001；与对照组（28%[14/50]相比，术后6个月时单独使用普瑞巴林和联合使用氯胺酮疼痛发生的比例分别为（6%[3/50]）、0%（0/5）；比值比分别为0.167[0.029-0.7]，P=0.006；和0.000[0-0.24]，P<0.0001）。

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结论
术前服用150mg普瑞巴林，术后连续14天每天服用两次，可显著降低心脏手术后持续疼痛的发生率。
原始文献来源：Anwar Sibtain,Cooper Jackie,Rahman Junia et al. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery.[J] .Anesthesiology, 2019, 131: 119-131.
英文/原文
Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery
Background: Persistent postsurgical pain is common and affects quality of life. The hypothesis was that use of pregabalin and ketamine would prevent persistent pain after cardiac surgery.
Method:This randomized, double-blind, placebo-controlled trial was undertaken at two cardiac surgery centers in the United Kingdom. Adults without chronic pain and undergoing any elective cardiac surgery patients via sternotomy were randomly assigned to receive either usual care, pregabalin (150 mg preoperatively and twice daily for 14 postoperative days) alone, or pregabalin in combination with a 48-h postoperative infusion of intravenous ketamine at 0.1 mg · kg · h. The primary endpoints were prevalence of clinically significant pain at 3 and 6 months after surgery, defined as a pain score on the numeric rating scale of 4 or higher (out of 10) after a functional assessment of three maximal coughs. The secondary outcomes included acute pain, opioid use, and safety measures, as well as long-term neuropathic pain, analgesic requirement, and quality of life.