Turker Gurkan, Goren Suna, Bayram Sami, Sahin Sukran, Korfali Gulsen
Department of Anesthesiology and Reanimation, Uludag University Medical School, 16059 Görükle/Bursa, Turkey.
J Cardiothorac Vasc Anesth. 2005 Aug;19(4):468-74. doi: 10.1053/j.jvca.2005.05.013.
The purpose of this study was to compare lumbar epidural morphine and lumbar epidural tramadol with respect to onset and duration of analgesia, analgesic efficacy, and drug-related side effects after muscle-sparing thoracotomy.
Prospective, randomized, double-blind, clinical study.
Single university hospital.
Forty patients who underwent elective muscle-sparing thoracotomy.
Before anesthesia induction, an epidural catheter was placed in the L2-3 or L3-4 interspace using the loss-of-resistance technique. On arrival at the intensive care unit, patients were randomized to receive doses of either 100 mg of tramadol (group T) or 4 mg of morphine (group M) via the lumbar epidural catheter. Each dose was diluted in 10 mL of normal saline. On awakening from anesthesia, if the patient's pain score on a 0- to 100-mm visual analog scale was above 40 mm, the initial epidural drug dose was administered. The initial injection in each case was taken as time 0. Subsequent pain scores above 40 mm were considered indications for epidural dosing; each patient was allowed 2 doses in the first 12 hours postoperatively and 2 more in the second 12 hours.
The groups' analgesia onset times were similar, but duration of analgesia was significantly shorter in group T than in group M (p < 0.01). There were no differences between the groups with respect to pain scores at rest or during coughing at any of the time points investigated. Sedation scores were lower in group T than in group M at 1, 2, 3, 4, and 8 hours (p value range, 0.0001-0.05). Compared with group T, group M showed significantly greater drops in arterial oxygen tension from baseline at 3, 4, 8, and 12 hours (p value range, 0.0001-0.05). The group means for arterial carbon dioxide tension and respiratory rate were similar at all time points investigated.
The study revealed that the quality of analgesia achieved with repeated doses of lumbar epidural tramadol after muscle-sparing thoracotomy is comparable to that achieved with repeated doses of lumbar epidural morphine. Compared with morphine, lumbar epidural tramadol results in less sedation and a less-pronounced decrease in oxygenation.
本研究旨在比较保留肌肉开胸术后腰段硬膜外注射吗啡和曲马多的镇痛起效时间、持续时间、镇痛效果及药物相关副作用。
前瞻性、随机、双盲临床研究。
单所大学医院。
40例行择期保留肌肉开胸术的患者。
麻醉诱导前，采用阻力消失法在L2-3或L3-4椎间隙置入硬膜外导管。患者入重症监护病房后，随机通过腰段硬膜外导管接受100 mg曲马多（T组）或4 mg吗啡（M组）。每剂药物用10 mL生理盐水稀释。麻醉苏醒后，若患者0至100 mm视觉模拟量表的疼痛评分高于40 mm，则给予初始硬膜外药物剂量。每例患者的首次注射记为时间0。后续疼痛评分高于40 mm被视为硬膜外给药指征；每位患者术后前12小时允许给药2次，后12小时再给药2次。
两组的镇痛起效时间相似，但T组的镇痛持续时间显著短于M组（p < 0.01）。在任何研究时间点，两组静息或咳嗽时的疼痛评分均无差异。T组在1、2、3、4和8小时的镇静评分低于M组（p值范围为0.0001 - 0.05）。与T组相比，M组在3、4、8和12小时时动脉血氧张力较基线的下降幅度显著更大（p值范围为0.0001 - 0.05）。在所有研究时间点，两组的动脉血二氧化碳分压和呼吸频率的组均值相似。
研究表明，保留肌肉开胸术后重复给予腰段硬膜外曲马多的镇痛质量与重复给予腰段硬膜外吗啡相当。与吗啡相比，腰段硬膜外曲马多导致的镇静作用较轻，氧合降低也不明显。
