Pang W W, Mok M S, Huang S, Hung C P, Huang M H
Department of Anesthesia, Show-Chwan Memorial Hospital, Changhua, Taiwan, ROC.
Can J Anaesth. 2000 Oct;47(10):968-73. doi: 10.1007/BF03024867.
To evaluate the adverse effect profile of tramadol by patient-controlled analgesia (PCA) with administration of the loading dose either intraoperatively or postoperatively.
Sixty adult patients scheduled for elective abdominal surgery were enrolled into this prospective, randomized, double blind study. The patients were anesthetized in a similar manner. At the beginning of wound closure, the patients were randomly allocated to receive 5 mg x kg(-1) tramadol (Group 1) or normal saline (Group 2). In the post-anesthesia care unit (PACU), when patients in either group complained of pain, 30 mg x ml(-1) tramadol i.v. were given every three minutes until visual analogue scale (VAS) 3, followed by tramadol PCA with bolus dose of 30 mg and five minute lockout interval. Pain control and adverse effect assessments were done in the PACU and every six hours for 48 hr post drug by an independent observer.
The loading dose was 290 +/- 45 mg in Group 1 and 315 +/- 148 mg in Group 2. In PACU, more nausea/vomiting both in terms of incidence (13/30, 43% vs 2/30, 6.6%, P < 0.05) and severity (nausea/vomiting score 2.5 +/- 2.0 vs 0.2 +/- 0.6, P < 0.05) was observed in patients with postoperative loading than in those with intraoperative loading of tramadol.
Administering the loading dose of tramadol during surgery decreases the nausea/vomiting associated with high dose of tramadol and improves the quality of tramadol PCA in the relief of postoperative pain.
通过患者自控镇痛（PCA）评估曲马多的不良反应情况，比较术中或术后给予负荷剂量曲马多的差异。
60例择期行腹部手术的成年患者纳入这项前瞻性、随机、双盲研究。患者接受相似方式的麻醉。在伤口缝合开始时，患者被随机分配接受5mg·kg⁻¹曲马多（第1组）或生理盐水（第2组）。在麻醉后恢复室（PACU），当两组患者主诉疼痛时，静脉注射30mg·ml⁻¹曲马多，每3分钟给药1次，直至视觉模拟评分（VAS）达到3分，随后进行曲马多PCA，单次剂量为30mg，锁定时间间隔为5分钟。由独立观察者在PACU进行疼痛控制和不良反应评估，并在给药后48小时内每6小时评估1次。
第1组的负荷剂量为290±45mg，第2组为315±148mg。在PACU中，术后给予负荷剂量曲马多的患者恶心/呕吐的发生率（13/30，43%对2/30，6.6%，P<0.05）和严重程度（恶心/呕吐评分为2.5±2.0对0.2±0.6，P<0.05）均高于术中给予负荷剂量曲马多的患者。
手术期间给予曲马多负荷剂量可减少与高剂量曲马多相关的恶心/呕吐，并改善曲马多PCA在缓解术后疼痛方面的质量。
