Unlügenç H, Ozalevli M, Güler T, Işik G
Cukurova University, Department of Anaesthesiology, Faculty of Medicine, Adana, Turkey.
Eur J Anaesthesiol. 2003 May;20(5):416-21. doi: 10.1017/s0265021503000644.
This double-blind randomized study tested whether the addition of magnesium or ketamine to morphine for intravenous patient-controlled analgesia resulted in improved analgesic efficacy and lower pain scores compared with morphine patient-controlled analgesia alone after major abdominal surgery.
Ninety patients (3 x 30) were randomly allocated to receive either morphine 0.4 mg mL(-1) (Group M) by patient-controlled analgesia, morphine 0.4mg mL(-1) + MgSO4 30mg mL(-1) (Group MM) or morphine 0.4 mg mL(-1) + ketamine 1 mg mL(-1) (Group MK). Postoperative analgesia was started when the verbal rating scale was > or = 2. Patients were first given a standardized loading dose (0.05 mg kg(-1)) of the study solution. They were then allowed to use bolus doses of this solution (0.0125 mg kg(-1) every 20 min without time limit). Discomfort, sedation, pain scores, cumulative morphine consumption and adverse effects were recorded up to 24 h after the start of the patient-controlled analgesia.
The level of discomfort, level of sedation and verbal rating scores decreased significantly with time in all groups (P < 0.05). Both verbal rating and discomfort scores were significantly lower in Groups MM and MK at 15, 30 and 60 min compared with Group M (P < 0.001). Cumulative morphine consumption after 12 and 24 h was significantly higher in Group M alone (median 26 and 49 mg, respectively) compared with Group MM (24.2 and 45.7 mg) and Group MK (24.4 and 46.5 mg).
In the immediate postoperative period, the addition of magnesium or ketamine to morphine for intravenous patient-controlled analgesia led to a significantly lower consumption of morphine. However, these differences are unlikely to be of any clinical relevance.
这项双盲随机研究旨在测试，在腹部大手术后，静脉自控镇痛时，与单纯吗啡自控镇痛相比，在吗啡中添加镁或氯胺酮是否能提高镇痛效果并降低疼痛评分。
90名患者（3×30）被随机分配，通过自控镇痛分别接受0.4mg/mL吗啡（M组）、0.4mg/mL吗啡+30mg/mL硫酸镁（MM组）或0.4mg/mL吗啡+1mg/mL氯胺酮（MK组）。当语言评分量表≥2分时开始术后镇痛。患者首先接受研究溶液的标准化负荷剂量（0.05mg/kg）。然后允许他们使用该溶液的推注剂量（每20分钟0.0125mg/kg，无时间限制）。记录自控镇痛开始后24小时内的不适、镇静、疼痛评分、吗啡累积消耗量及不良反应。
所有组的不适程度、镇静程度和语言评分随时间均显著降低（P<0.05）。与M组相比，MM组和MK组在15、30和60分钟时的语言评分和不适评分均显著更低（P<0.001）。单独的M组在12小时和24小时后的吗啡累积消耗量显著高于MM组（分别为中位数26mg和49mg）和MK组（24.2mg和45.7mg）（24.4mg和46.5mg）。
在术后即刻，静脉自控镇痛时在吗啡中添加镁或氯胺酮可显著降低吗啡消耗量。然而，这些差异不太可能具有任何临床相关性。
