Effect of Opioid-free Analgesia and Anesthesia on the Quality of Postoperative Recovery and Nausea Vomit in Patients Receiving Laparoscopic Sleeve Gastrectomy
Overview
- Phase
- Not Applicable
- Intervention
- Opioid-free Analgesics (esketamine, dexmedetomidine)
- Conditions
- Opioid-Free Anesthesia
- Sponsor
- Beijing Friendship Hospital
- Enrollment
- 76
- Locations
- 1
- Primary Endpoint
- 15-item recovery quality scale score 48 hours after surgery
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
The purpose of the intraoperative use of opioids is to reduce the amount of sedative medication and to ensure effective analgesia. But pain is an unpleasant sensory and emotional experience (a cognitive perception) that cannot occur with sufficient depth of anesthesia (even without opioids). So a more reasonable explanation for analgesia should be anti-nociception and the resulting inhibition of the response to surgical stress. Since multiple mediators are involved in nociceptive pathways, antinociception can also be acquired through multiple mechanisms. However, there is no single ideal harm drug to replace opioids, which often requires two or more drugs to meet clinical needs. While regional block attenuates the stress response to surgery and sympathetic activation because of afferents to block nociceptive stimuli, and has an important role in the implementation of OFA. Combined with the clinical characteristics of the LSG, investigators developed the transverse abdominis fascia block (transversus abdominis plane TAP) in combination with esketamine (esketamine), dexmedetomidine (dexmedetomidine, DEX) of opioid-free anesthesia (opioid free anesthesia, OFA) and the analgesic regimen (TEDOFA), Reduce patient pain scores, nausea and vomiting after LSG based on perfect analgesia and adequate anti-sympathetic response, As well as the other complications, Promote the accelerated postoperative recovery of patients undergoing LSG, And reduce the incidence and severity of postoperative chronic pain.
Investigators
Bijia Song
principal investigator
Beijing Friendship Hospital
Eligibility Criteria
Inclusion Criteria
- •Patients undergoing elective laparoscopic sleeve gastrectomy
- •ASAA I or grade;
- •volunteered in this trial and signed informed consent; ④ age 18-65 years; ⑤ BMI\> 30kg / m2.
Exclusion Criteria
- •chronic pain;
- •severe liver dysfunction (total bilirubin 2 mg dl-1);
- •severe renal dysfunction (glomerular filtration rate 60ml min-1 1.73m-2);
- •pregnancy or lactation;
- •preoperative heart rate \<50 beats / min, sick sinus syndrome, severe heart block; -dementia or significant neurological disorders (such as stroke, epilepsy, intracranial tumors, PD, etc.);
- •history of alcohol or drug abuse
Arms & Interventions
Opioid-free group
Intervention: Opioid-free Analgesics (esketamine, dexmedetomidine)
Opioid group
Intervention: Opioid Anesthetics (sufentanil and remifentanil)
Outcomes
Primary Outcomes
15-item recovery quality scale score 48 hours after surgery
Time Frame: 48 hours after surgery
The QoR-15 scale is a global measure of postoperative recovery, with scores ranging from 0 (extremely poor QoR) to 150 (excellent QoR). QoR-15 has become the most widely reported indicator for the evaluation of postoperative life treatment in patients. Using wherever possible QoR-15 item scores on postoperative day 3, QoR-15 with very good validity, and good reliability, responsiveness and clinical acceptability, these data suggest that QoR-15 is an excellent patient-centered measure of postoperative QoR. Patient Acceptable symptom status describes the lowest absolute score considered by the patient to represent a healthy or good status health scale. A QoR-15 score of 118 or more indicates a good postoperative recovery
15-item recovery quality scale score 24 hours before surgery
Time Frame: 24 hours before surgery
The QoR-15 scale is a global measure of postoperative recovery, with scores ranging from 0 (extremely poor QoR) to 150 (excellent QoR). QoR-15 has become the most widely reported indicator for the evaluation of postoperative life treatment in patients. Using wherever possible QoR-15 item scores on postoperative day 3, QoR-15 with very good validity, and good reliability, responsiveness and clinical acceptability, these data suggest that QoR-15 is an excellent patient-centered measure of postoperative QoR. Patient Acceptable symptom status describes the lowest absolute score considered by the patient to represent a healthy or good status health scale. A QoR-15 score of 118 or more indicates a good postoperative recovery
15-item recovery quality scale score 24 hours after surgery
Time Frame: 24 hours after surgery
The QoR-15 scale is a global measure of postoperative recovery, with scores ranging from 0 (extremely poor QoR) to 150 (excellent QoR). QoR-15 has become the most widely reported indicator for the evaluation of postoperative life treatment in patients. Using wherever possible QoR-15 item scores on postoperative day 3, QoR-15 with very good validity, and good reliability, responsiveness and clinical acceptability, these data suggest that QoR-15 is an excellent patient-centered measure of postoperative QoR. Patient Acceptable symptom status describes the lowest absolute score considered by the patient to represent a healthy or good status health scale. A QoR-15 score of 118 or more indicates a good postoperative recovery
Secondary Outcomes
- Dosage of postoperative analgesics(48 hours after surgery)
- time of first postoperative mobilization(24 hours after surgery)
- time to first exhaust gas after surgery(24 hours after surgery)
- Acute pain numeric rating scale score(6, 24, 48 hours after surgery)
- Duration of until postoperative PACU Aldrete score> 9 points(up to 30 min after surgery at postoperative recovery room)
- anesthesia-related complication(24 hours after surgery)
- Overall benefit of analgesic score satisfaction in pain treatment(6, 24, 48 hours after surgery)
- Rhodes Index of Nausea, Vomiting, and Retching(6, 24, 48 hours after surgery)