Pang Wei-Wu, Wu Hurng-Sheng, Lin Ching-Hsiung, Chang Da-Peng, Huang Min-Ho
Department of Anesthesia, Show-Chwan Memorial Hospital Changhua, Taiwan, ROC.
Can J Anaesth. 2002 Dec;49(10):1029-33. doi: 10.1007/BF03017896.
To evaluate the clinical benefits and disadvantages of adding metoclopramide to tramadol for patient-controlled analgesia (PCA).
Forty adult patients, undergoing elective arthroplasties, were recruited into this prospective, randomized, double-blind study. During general anesthesia all patients received 2.5 mg x kg(-1) of tramadol as a loading dose at the beginning of wound closure. In the postanesthesia care unit (PACU) patients were randomly allocated to receive PCA containing either 20 mg tramadol + 1 mg metoclopramide per millilitre (n = 20, Group T+M) or tramadol 20 mg per millilitre (n = 20, Group T). The PCA setup was 1 mL/bolus with a lockout interval of five minutes. A blinded investigator assessed the vital signs, visual analogue scale, and severity of postoperative nausea and/or vomiting in the PACU. The PCA demand and delivery, overall satisfaction rate and adverse effects were recorded in the PACU and on postoperative days one and two.
Nausea/vomiting scores were more severe (1.7 +/- 1.0 vs 0.2 +/- 0.5, 2.3 +/- 1.2 vs 0.6 +/- 0.6, 1.9 +/- 0.9 vs 0.2 +/- 0.5, at 12 hr, 18 hr, 24 hr, respectively, P < 0.05) and more frequent (7/20 vs 1/20, 5/20 vs 0/20 for nausea and vomiting respectively, P < 0.05) on postoperative day one in Group T compared to Group T+M. However, the incidence of sedation was higher in Group T+M (7/20 vs 1/20, P < 0.05).
The incidence and severity of nausea/vomiting decreased if metoclopramide was added to tramadol for PCA. An increased incidence of sedation was noticed with this drug combination.
评估在曲马多用于患者自控镇痛（PCA）时加用甲氧氯普胺的临床利弊。
40例接受择期关节置换术的成年患者被纳入这项前瞻性、随机、双盲研究。在全身麻醉期间，所有患者在伤口缝合开始时接受2.5mg/kg⁻¹的曲马多作为负荷剂量。在麻醉后护理单元（PACU），患者被随机分配接受每毫升含20mg曲马多+1mg甲氧氯普胺的PCA（n = 20，T+M组）或每毫升含20mg曲马多的PCA（n = 20，T组）。PCA设置为1mL/推注，锁定间隔为5分钟。一名盲法研究者评估PACU中的生命体征、视觉模拟评分以及术后恶心和/或呕吐的严重程度。记录PACU以及术后第1天和第2天的PCA需求和给药量、总体满意率及不良反应。
与T+M组相比，T组术后第1天恶心/呕吐评分更严重（分别在12小时、18小时、24小时时为1.7±1.0对0.2±0.5、2.3±1.2对0.6±0.6、1.9±0.9对0.2±0.5，P<0.05）且更频繁（恶心分别为7/20对1/20，呕吐分别为5/20对0/20，P<0.05）。然而，T+M组镇静发生率更高（7/20对1/20，P<0.05）。
在曲马多用于PCA时加用甲氧氯普胺可降低恶心/呕吐的发生率和严重程度。但这种药物组合会使镇静发生率增加。
