RESUMO
Objective:To systematically compare the efficacy of different drugs in alleviating remifentanil-induced hyperalgesia.Methods:Databases such as PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang Data and CBM were searched using computers from inception to May 2020.The randomized controlled trials comparing the efficacy of different intervention measures for alleviating remifentanil-induced hyperalgesia were searched.After independently identifying the literature, the two reviewers conducted data extraction and evaluated the bias of the included studies, and Stata 14.0, ADDIS 1.16.5 and R4.0.2 softwares were used to analyze the data.Results:Thirty randomized controlled trials were included in our study.Compared with placebo, 3 out of 6 drugs could alleviate remifentanil-induced hyperalgesia, and the probability order for the effect was as follows: butorphanol with MD value (95% CI)-1.50 (-2.80, -0.24), dexmedetomidine with MD value (95% CI)-1.20 (-2.40, -0.09) and ketamine with MD value (95% CI) -0.88 (-1.60, -0.16). After sensitivity analysis, the efficacy of butorphanol remained to be verified.Two drugs could decrease the dosage of opioids within 24 h after operation, and the probability order for the effect was as follows: dexmedetomidine with MD value (95% CI) -14.00 (-28.00, -0.19) and ketamine with MD value (95% CI) -9.20 (-18.00, -0.08). One drug could decrease the incidence of postoperative nausea and vomiting within 24 h after operation: dexmedetomidine with RR value (95%CI) 0.28 (0.16, 0.22). Conclusion:The results of network meta-analyses show that dexmedetomidine has the best efficacy in alleviating remifentanil-induced hyperalgesia.
RESUMO
Objective:To evaluate the optimized efficacy of sevoflurane inhalation combined with caudal ropivacaine for abdominal surgery in low birth weight neonates.Methods:Eighty low birth weight neonates of either sex, with gestational age<37 weeks, weighing 1.5-2.5 kg, of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective laparotomy, were divided into 2 groups ( n=40 each) using a random number table method: sevoflurane combined with caudal block with ropivacaine group (SCB group) and sevoflurane plus remifentanil group (SR group). Anesthesia was induced and maintained with sevoflurane inhalation in the two groups.Caudal anesthesia was performed with 0.2% ropivacaine 1 ml/kg in the left lateral position after successful intubation in group SCB.Cis-atracurium 0.1 mg/kg was given, and remifentanil was infused at 0.5 μg·kg -1·min -1 in group SR.Inhaling sevoflurane was stopped at the end of operation in the two groups, and rescue analgesia was performed when the FLACC score was greater than 3 within 6 h after operation.The operation time, emergence time, extubation time, and duration of postanesthesia care unit (PACU) stay were recorded.The occurrence of adverse reactions during the emergence period and PACU stay and requirement for rescue analgesia within 6 h after surgery were recorded.The complications of caudal block were recorded in group SCB. Results:There was no significant difference in the operation time between the two groups ( P>0.05). Compared with group SR, the emergence time, extubation time, and duration of PACU stay were significantly shortened, and the incidence of adverse reactions during the emergence period and PACU stay and requirement for rescue analgesia within 6 h after surgery were decreased in group SCB ( P<0.05). The caudal block-related complications were not found in group SCB. Conclusion:Sevoflurane combined with caudal ropivacaine can be used as an optimized strategy helpful for the quality of anesthesia recovery in low birth weight newborns undergoing abdominal surgery.