Antonucci S
Servizio di Anestesia e Rianimazione, ASL Pescara, Ospedale SS. Trinitá, Popoli (Pescara), Italy.
Minerva Anestesiol. 2001 Jan-Feb;67(1-2):23-7.
Evaluated effects of tramadol used as adiuvant in brachial plexus block and compared with clonidine and sufentanil.
Randomized, prospectic study with 80 patients, ASA status I-II, undergoing carpal tunnel release performed under axillary plexus block with ropivacaine 0.75% 20 ml divided in 4 study groups: tramadolo 100 mg (Group T), clonidina 1.5 g/kg (Group C), sufentanil 20 g (Group S) in 5 ml. of NaCl. Control (Group F) NaCl 5 ml. Adeguacy of the block was evaluated using pinprick test ( three points scale) and a temperature test. Onset time, duration of analgesia and anesthesia were recorded. Also during the surgery the sedation score on a five-point scale was evaluated and were recorded episodes of hypotension, bradycardia, Sp02<90% and other side effects. Results are reported as median+/-SD. For statistical analysis ANOVA test, Bonferroni test and c2 test were used.
Onset time of anesthesia showed significant difference between three study groups than control group, while no significant differences was recordered between groups S, C and T (S: 11+/-7 min; C: 12+/-4 min; T: 14+/-8 min; F: 20+/-11 min.). Same results were obtained among duration of anesthesia and analgesia, that were lower in F group. An adeguate quality of block for surgery was obtained in 79 patients. Only one patients of F group needed surgical infiltration. A significant difference was recordered among quality of anesthesia between group F and other three study groups. Highest sedation score was noted in C and S groups. Significantly highest incidence of bradycardia and hypotension episodes were observed in group C.
The use of tramadol as adiuvant provides a significative redution of onset time. Also provides a prolongation of anesthesia and analgesia with a quality of block similar that obtained with clonidine and sufentanil and a lower incidence of side effects of clonidine (sedation, bradycardia and hypotension) and sufentanil(itch and sedation). We conclude that tramadol may be a useful alternative, as adiuvant in periferic block, with same effects of other drugs commonly used and a lower incidence of side effects.
评估曲马多作为辅助药物用于臂丛神经阻滞的效果，并与可乐定和舒芬太尼进行比较。
对80例ASA分级为I-II级、接受腕管松解术的患者进行随机、前瞻性研究，手术在腋路臂丛神经阻滞下进行，使用0.75% 20 ml罗哌卡因，分为4个研究组：曲马多100 mg（T组）、可乐定1.5 μg/kg（C组）、舒芬太尼20 μg（S组），均用5 ml氯化钠溶液稀释。对照组（F组）给予5 ml氯化钠溶液。使用针刺试验（三分制）和温度试验评估阻滞效果。记录起效时间、镇痛和麻醉持续时间。在手术过程中，还评估了五分制镇静评分，并记录低血压、心动过缓、SpO₂<90%及其他副作用的发生情况。结果以中位数±标准差表示。采用方差分析、Bonferroni检验和卡方检验进行统计学分析。
麻醉起效时间在三个研究组与对照组之间存在显著差异，而S组、C组和T组之间无显著差异（S组：11±7分钟；C组：12±4分钟；T组：14±8分钟；F组：20±11分钟）。麻醉和镇痛持续时间也得到相同结果，F组持续时间较短。79例患者获得了足够的手术阻滞质量。只有F组的1例患者需要手术浸润。F组与其他三个研究组的麻醉质量存在显著差异。C组和S组的镇静评分最高。C组观察到显著更高的心动过缓和低血压发作发生率。
使用曲马多作为辅助药物可显著缩短起效时间。还能延长麻醉和镇痛时间，其阻滞质量与可乐定和舒芬太尼相似，且可乐定（镇静、心动过缓和低血压）和舒芬太尼（瘙痒和镇静）的副作用发生率较低。我们得出结论，曲马多作为外周阻滞的辅助药物可能是一种有用的替代药物，与常用的其他药物效果相同且副作用发生率较低。
