Weinbroum Avi A, Bender Benjamin, Nirkin Alexander, Chazan Shoshana, Meller Isaac, Kollender Yehuda
Postanesthesia Care Unit, the Acute Pain Service, Tel Aviv Sourasky Medical Center and the Sackler Faculty Medicine, Tel Aviv University, Tel Aviv, Israel.
Anesth Analg. 2004 Mar;98(3):714-22, table of contents. doi: 10.1213/01.ane.0000100151.56901.eb.
Pain after bone malignancy surgery is intense and requires large amounts of analgesics. The augmented antinociceptive effects of dextromethorphan (DM), a N-methyl-D-aspartate receptor antagonist, were demonstrated previously. We assessed the use of postoperative patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) in patients undergoing surgery for bone malignancy under standardized combined general and epidural anesthesia with or without DM. Patients (n = 120) were randomly allocated to receive PCEA (ropivacaine 3.2 mg plus fentanyl 8 microg/dose) or IV-PCA (morphine 2 mg/dose) postoperatively, starting at subjective visual analog scale pain intensity >or=4 of 10 for up to 96 h. Placebo or DM 90 mg orally (30 patients/group/set) was given in a double-blinded manner before surgery and for 2 days afterwards. Diclofenac 75 mg IM was available as a rescue drug. DM patients used PCA and rated their pain >50% less than their placebo counterparts in each set, especially during the first 2 postoperative days (P < 0.01). Hourly and overall maximal pain intensity among PCEA patients was approximately 50% less than in the IV-PCA set (P < 0.01). Diclofenac was used 42% less (P < 0.01) by the PCA-DM patients compared with their placebo counterparts. Seven PCEA-DM and 11 IV-PCA-DM individuals reported having side effects compared with 44 in the PCEA-placebo and the IV-PCA-placebo groups (P < 0.01). Time to first ambulation was similar with both analgesia techniques but shorter among the DM-treated patients compared with the placebo recipients (1.5 +/- 0.8 versus 2.1 +/- 1.1 days, P = 0.02). Thus, DM afforded better pain control and reduced the demand for analgesics, augmented the PCEA effect versus IV-PCA, and was associated with minimal untoward effects in each analgesia set. DM patients ambulated earlier than placebo recipients.
Patients undergoing bone-malignancy surgery under combined general and epidural anesthesia received randomly patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) postoperatively and dextromethorphan (DM) 90 mg or placebo double-blindly for 3 days (n = 30/group/set). The DM effect was recorded with minimal untoward effects: it afforded better pain control and reduced the demand for analgesics compared with the placebo, especially when associated with PCEA. DM patients ambulated earlier than placebo recipients.
骨恶性肿瘤手术后疼痛剧烈，需要大量镇痛药。右美沙芬（DM）作为一种N-甲基-D-天冬氨酸受体拮抗剂，其增强的抗伤害感受作用此前已得到证实。我们评估了在标准化的全身麻醉与硬膜外麻醉联合使用或不使用DM的情况下，接受骨恶性肿瘤手术的患者术后使用患者自控硬膜外镇痛（PCEA）或静脉自控镇痛（PCA）的情况。患者（n = 120）被随机分配在术后接受PCEA（罗哌卡因3.2 mg加芬太尼8 μg/剂量）或静脉PCA（吗啡2 mg/剂量），起始于主观视觉模拟评分疼痛强度≥4（满分10分），持续96小时。在手术前及术后2天以双盲方式给予安慰剂或口服DM 90 mg（每组/每组30例患者）。双氯芬酸75 mg肌内注射作为急救药物备用。在每组中，DM组患者使用PCA，其疼痛评分比安慰剂组患者低50%以上，尤其是在术后的前两天（P < 0.01）。PCEA组患者的每小时及总体最大疼痛强度比静脉PCA组患者低约50%（P < 0.01）。与安慰剂组患者相比，PCA-DM组患者使用双氯芬酸的量减少了42%（P < 0.01）。与PCEA-安慰剂组和静脉PCA-安慰剂组的44例患者相比，7例PCEA-DM组和11例静脉PCA-DM组患者报告有副作用（P < 0.01）。两种镇痛技术的首次下床活动时间相似，但与安慰剂组患者相比，DM治疗组患者的首次下床活动时间更短（1.5 ± 0.8天对2.1 ± 1.1天，P = 0.02）。因此，DM提供了更好的疼痛控制，减少了对镇痛药的需求，增强了PCEA相对于静脉PCA的效果，并且在每组镇痛中产生的不良反应最小。DM组患者比安慰剂组患者更早下床活动。
在全身麻醉与硬膜外麻醉联合的情况下接受骨恶性肿瘤手术的患者，术后随机接受患者自控硬膜外镇痛（PCEA）或静脉自控镇痛（PCA），并双盲接受90 mg右美沙芬（DM）或安慰剂治疗3天（每组/每组30例）。记录了DM的效果，且不良反应最小：与安慰剂相比，它提供了更好的疼痛控制并减少了对镇痛药的需求，尤其是与PCEA联合使用时。DM组患者比安慰剂组患者更早下床活动。
