Holthusen Holger, Backhaus Peter, Boeminghaus Frank, Breulmann Maria, Lipfert Peter
Department of Anesthesiology, Heinrich-Heine-University, Duesseldorf, Germany.
Reg Anesth Pain Med. 2002 May-Jun;27(3):249-53. doi: 10.1053/rapm.2002.30669.
Preemptive analgesia often failed in the clinical arena because application of a single intravenously applied drug may not prevent nociceptive input and spinal pain processing sufficiently. We therefore used an intravenous (IV), multireceptor approach and tested the preemptive analgesic effect of the antinociceptive drugs morphine, ketamine, and clonidine given before or immediately after surgery.
A double-blind, randomized, prospective study was performed in 30 patients undergoing transperitoneal tumor nephrectomy (via median laparotomy). Standard general anesthesia procedure without opioids was used. After induction, patients were randomly allocated to receive 150 microg x kg(-1) of morphine, 150 microg x kg(-1) of ketamine, and 5 microg x kg(-1) of clonidine intravenously via a motor-driven pump within 15 minutes, either before or immediately after surgery. Patient-controlled analgesia (PCA) with the opioid piritramide (IV) was used for postoperative analgesia. Postoperative pain at rest and during induced cough was quantified by analgesic requirement and pain scores (visual analog scale [VAS]) within 48 hours.
There was no significant difference in analgesic requirement of piritramide and pain scores at rest or during induced cough.
In contrast to encouraging observations on the combination of antinociceptive drugs, the multireceptor approach tested here failed to exert a clinically relevant effect.
预先镇痛在临床实践中常常失败，因为单一静脉给药可能无法充分预防伤害性刺激输入和脊髓疼痛处理过程。因此，我们采用静脉内多受体方法，测试了手术前或手术后立即给予的抗伤害性药物吗啡、氯胺酮和可乐定的预先镇痛效果。
对30例行经腹肿瘤肾切除术（经正中剖腹术）的患者进行了一项双盲、随机、前瞻性研究。采用无阿片类药物的标准全身麻醉程序。诱导后，患者被随机分配在手术前或手术后15分钟内通过电动泵静脉注射150μg·kg⁻¹吗啡、150μg·kg⁻¹氯胺酮和5μg·kg⁻¹可乐定。术后镇痛采用阿片类药物匹米诺定的患者自控镇痛（PCA）。术后48小时内，通过镇痛需求量和疼痛评分（视觉模拟量表[VAS]）对静息和诱发咳嗽时的术后疼痛进行量化。
匹米诺定的镇痛需求量以及静息或诱发咳嗽时的疼痛评分均无显著差异。
与抗伤害性药物联合使用的令人鼓舞的观察结果相反，这里测试的多受体方法未能产生临床相关效果。
