Ranucci M, Cazzaniga A, Soro G, Isgrò G, Rossi R, Pavesi M
Dipartimento di Cardioanestesia, Università degli Studi, Milano.
Minerva Anestesiol. 1999 Dec;65(12):859-65.
Early extubation after cardiac surgery is a procedure recently gaining interest due to its ability to shorten intensive care unit and hospital stay and to limit the operation-related costs. Its use, however, raised new problems in terms of pain control in the early postoperative course, due to the need for limiting opioid analgesia. This study deals with non-opioid pain control after cardiac surgery and early extubation.
Prospective, randomized trial aimed to investigate the effectiveness of three intravenous analgesic drugs (ketorolac, 60 mg i.v.; propacetamol, 2 g i.v.; tramadol, 200 mg i.v.) for the management of postoperative pain in early extubated cardiac surgical patients. Each treatment group comprised 20 patients.
The pain assessment (5-item verbal scale) demonstrated a significant (p < 0.05) lower value in patients treated with ketorolac vs propacetamol, while patients treated with tramadol did not significantly differ from the other two groups. There was a significantly (p < 0.05) higher rate of patients with severe pain in propacetamol group. Patients treated with tramadol had a significantly (p < 0.01) higher PaCO2 (48 +/- 6 mmHg) versus patients treated with ketorolac (43.4 +/- 3.7 mmHg) or propacetamol (42.9 +/- 3.4 mmHg).
Tramadol and ketorolac seem to be the best options for treating postoperative pain in the specific setting of early extubation after cardiac surgery; high doses of tramadol may result in a significant even if clinically not relevant respiratory depression.
心脏手术后早期拔管是一种近来受到关注的操作，因为它能够缩短重症监护病房住院时间和医院住院时间，并限制手术相关费用。然而，由于需要限制阿片类镇痛药物的使用，其应用在术后早期疼痛控制方面引发了新问题。本研究探讨心脏手术后早期拔管后的非阿片类疼痛控制。
前瞻性随机试验旨在研究三种静脉镇痛药物（酮咯酸，静脉注射60毫克；丙帕他莫，静脉注射2克；曲马多，静脉注射200毫克）用于早期拔管心脏手术患者术后疼痛管理的有效性。每个治疗组包括20名患者。
疼痛评估（5项言语量表）显示，与丙帕他莫治疗的患者相比，酮咯酸治疗的患者疼痛值显著更低（p<0.05），而曲马多治疗的患者与其他两组无显著差异。丙帕他莫组严重疼痛患者的比例显著更高（p<0.05）。与酮咯酸治疗的患者（43.4±3.7毫米汞柱）或丙帕他莫治疗的患者（42.9±3.4毫米汞柱）相比，曲马多治疗的患者PaCO2显著更高（p<0.01）（48±6毫米汞柱）。
曲马多和酮咯酸似乎是心脏手术后早期拔管特定情况下治疗术后疼痛的最佳选择；高剂量曲马多可能导致显著的呼吸抑制，即使在临床上无相关性。
