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Comparison of opioid‐free and opioid‐inclusive propofol anaesthesia for thyroid and parathyroid surgery: a randomised controlled trial

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اقرأ أكثر حفظ في قائمتي
  • معلومة اضافية
    • Publisher Information:
      eScholarship, University of California 2024-07-22
    • نبذة مختصرة :
      BackgroundPostoperative nausea and vomiting occur frequently following thyroid and parathyroid surgery and are associated with worse patient outcomes. We hypothesised that opioid-free propofol anaesthesia would reduce the incidence of postoperative nausea and vomiting compared with opioid-inclusive propofol anaesthesia in patients undergoing these procedures.MethodsWe conducted a randomised, double-blinded controlled trial in adult patients scheduled to undergo thyroid and parathyroid surgery at two medical centres in mainland China. Patients were allocated randomly (1:1, stratified by sex and trial site) to an opioid-free anaesthesia group (esketamine, lidocaine, dexmedetomidine and propofol) or an opioid-inclusive group (sufentanil and propofol). Propofol infusions were titrated to bispectral index 45-55. Patients received prophylaxis for nausea and vomiting using dexamethasone and ondansetron and multimodal analgesia with paracetamol and flurbiprofen axetil. The primary outcome was the incidence of postoperative nausea and vomiting in the first 48 h after surgery.ResultsWe assessed 557 patients for eligibility and 394 completed this trial. The incidence of postoperative nausea and vomiting in the first postoperative 48 h was lower in the opioid-free anaesthesia group (10/197, 5%) compared with opioid-inclusive group (47/197, 24%) (OR (95%CI) 0.17 (0.08-0.35), p < 0.001), yielding a number needed to treat of 5.3. Additionally, opioid-free propofol anaesthesia was associated with a reduced need for rescue anti-emetics, lower rates of hypotension and desaturation after tracheal extubation, and higher patient satisfaction. Time to tracheal extubation was prolonged slightly in the opioid-free group. The two groups had similar postoperative pain scores and 30-day outcomes.DiscussionOpioid-free propofol anaesthesia reduced postoperative nausea and vomiting in patients undergoing thyroid and parathyroid surgery. An opioid-free anaesthetic regimen can optimise anaesthe
    • الموضوع:
      Biomedical and Clinical Sciences; Clinical Sciences; Opioid Misuse and Addiction; Pain Research; Clinical Research; Opioids; Clinical Trials and Supportive Activities; Substance Misuse; 6.1 Pharmaceuticals; opioid‐free anaesthesia; postoperative nausea and vomiting; propofol anaesthesia; thyroid and parathyroid surgery; Neurosciences; Anesthesiology; Clinical sciences; Dentistry; publication
    • Availability:
      Open access content. Open access content
      CC-BY
    • Note:
      application/pdf
    • Other Numbers:
      CDLER oai:escholarship.org:ark:/13030/qt5n52t6j5
      qt5n52t6j5
      https://escholarship.org/uc/item/5n52t6j5
      https://escholarship.org/content/qt5n52t6j5/qt5n52t6j5.pdf
      info:doi/10.1111/anae.16382
      https://escholarship.org/
      1452696624
    • Contributing Source:
      UC MASS DIGITIZATION
      From OAIster®, provided by the OCLC Cooperative.
    • الرقم المعرف:
      edsoai.on1452696624
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