Dejonckheere M, Desjeux L, Deneu S, Ewalenko P
Department of Anaesthesia, Institut Jules Bordet, Rue H. Bordet 1, 1000 Brussels, Belgium.
Acta Anaesthesiol Belg. 2001;52(1):29-33.
We compared the efficacy and side effects of propacetamol (P), an injectable prodrug of acetaminophen, 2 g and tramadol (T), a weak synthetic opioid, 1.5 mg.kg-1, given intravenously following thyroidectomy. 80 patients were randomly assigned to blindly receive one dose of P or T on request in the PACU. Residual pain was treated with i.v. PCA morphine. Pain and patient satisfaction were assessed with Visual Analog Scales. Demographic and peroperative data were comparable in both groups. Although the morphine consumption was comparable (p = 0.71), the decrease in VAS pain scores was significantly higher following tramadol (p = 0.03). More patients complained of nausea and vomiting (p = 0.01) during the first two hours following injection of tramadol, but there was no difference throughout the whole study. Oversedation was not observed in any group. We conclude that a single dose of tramadol provides a better quality of analgesia than propacetamol during the first six hours after thyroidectomy, but fails to ensure optimal analgesia, since VAS pain scores failed to fall below 3 despite the use of supplemental morphine.
我们比较了对乙酰氨基酚的注射用前体药物丙帕他莫（P）2 g与弱合成阿片类药物曲马多（T）1.5 mg·kg-1在甲状腺切除术后静脉注射的疗效和副作用。80例患者在麻醉后恢复室（PACU）中根据需要被随机分配，盲法接受一剂P或T。残余疼痛用静脉自控镇痛（PCA）吗啡治疗。采用视觉模拟评分法评估疼痛和患者满意度。两组的人口统计学和手术数据具有可比性。虽然吗啡消耗量相当（p = 0.71），但曲马多注射后视觉模拟评分（VAS）疼痛评分的下降明显更高（p = 0.03）。更多患者在注射曲马多后的头两小时内出现恶心和呕吐（p = 0.01），但在整个研究过程中没有差异。两组均未观察到过度镇静。我们得出结论，在甲状腺切除术后的头六个小时内，单剂量曲马多比丙帕他莫提供更好的镇痛质量，但未能确保最佳镇痛效果，因为尽管使用了补充吗啡，VAS疼痛评分仍未降至3以下。
