以艾司氯胺酮为基础的无阿片麻醉对减重手术患者术后疼痛和心理健康结局的双重获益：一项随机对照试验。
完整摘要 · 中文译文
病态肥胖患者合并抑郁和焦虑症状的风险很高。虽然减重手术是一种有效的治疗方法，但传统的阿片类药物麻醉具有显著的围手术期风险。无阿片麻醉（OFA）是一种更安全的选择。艾司氯胺酮以其兼具镇痛和快速抗抑郁作用而著称，是无阿片麻醉中一个有前景的组成部分。然而，支持其在减重手术患者中同时促进身心恢复的临床证据仍然有限。在这项双盲、随机临床试验中，计划接受腹腔镜袖状胃切除术的患者被随机分配（1：1），在手术期间接受基于艾司氯胺酮的麻醉或使用瑞芬太尼的阿片类药物麻醉。共同主要结局为术后最初24小时内的疼痛强度以及术后三个月时的心理健康状况。次要结局包括艾司氯胺酮的药代动力学和不良事件。共有84例患者被随机分组，每组42例。74名参与者（88.1%）完成了3个月的随访。艾司氯胺酮组患者术后24小时内疼痛强度显著更低（P < 0.01），中重度疼痛的发生率也降低（P < 0.05）。3个月时的心理健康结局在艾司氯胺酮组也显著更好，不良事件发生率无显著差异。药代动力学分析显示，输注期间血浆艾司氯胺酮浓度迅速升高，并早期生成 活性代谢物(S)-去甲氯胺酮。与基于阿片类药物的麻醉相比，基于艾司氯胺酮的无阿片麻醉在接受减重手术的病态肥胖患者中与术后镇痛改善和心理健康结局更佳相关，且不增加不良事件。
完整摘要 · 英文原文
Patients with morbid obesity are at a high risk of comorbid depressive and anxiety symptoms. While bariatric surgery is an effective treatment, conventional opioid-based anesthesia carries significant perioperative risks. Opioid-free anesthesia (OFA) presents a safer alternative. Esketamine, known for its dual analgesic and rapid antidepressant effects, is a promising component of OFA. However, clinical evidence supporting its simultaneous benefits for both physical and psychological recovery in bariatric patients remains limited. In this double-blind, randomized clinical trial, patients scheduled for laparoscopic sleeve gastrectomy were randomly assigned (1:1) to receive either esketamine-based anaesthesia or opioid-based anaesthesia with remifentanil during surgery. The co-primary outcomes were postoperative pain intensity within the first 24 h and mental health status at three months after surgery. Secondary outcomes included pharmacokinetics of esketamine and adverse events. A total of 84 patients were randomized, with 42 allocated to each group. Seventy-four participants (88.1%) completed the 3-month follow-up. Patients in the esketamine group experienced significantly lower postoperative pain intensity (P < 0.01) and a reduced incidence of moderate-to-severe pain (P < 0.05) within 24 h after surgery. Mental health outcomes at 3 months were also significantly better in the esketamine group, and adverse events rate did not differ significantly. Pharmacokinetic analysis showed that plasma esketamine concentrations increased rapidly during infusion, with early formation of the active metabolite (S)-norketamine. Compared to opioid-based anaesthesia, esketamine-based opioid-free anaesthesia was associated with improved postoperative analgesia and better mental health outcomes in morbidly obese patients undergoing bariatric surgery, without increasing adverse events.