Ozalevli Mehmet, Unlügenç Hakki, Tuncer Ulkü, Güneş Yasemin, Ozcengiz Dilek
Department of Anesthesiology, School of Medicine, Cukurova University, Adana, Turkey.
Paediatr Anaesth. 2005 Nov;15(11):979-84. doi: 10.1111/j.1460-9592.2005.01591.x.
Tramadol is an alternative to other opioids for postoperative pain management. This prospective, randomized, double-blind study was designed to compare the analgesic efficacy of patient-controlled tramadol with patient-controlled morphine for postoperative pain after tonsillectomy in children.
Sixty patients were allocated randomly to receive a patient-controlled analgesia (PCA) with either tramadol (T) or morphine (M), in a double-blind randomized study. When surgery was completed and hemostasis achieved, a standardized loading dose (0.1 mg.kg(-1) in group M, or 1 mg.kg(-1) in group T) was given. Thereafter, the children helped themselves to bolus doses (morphine (0.02 mg.kg(-1)) or tramadol (0.2 mg.kg(-1)) with lock-out times of 10 min without time limit via a PCA device. Scores for pain, sedation, nausea, and the bolus and total PCA doses, hemodynamic parameters and side effects were recorded at 5, 15, 30 min and 1, 2, 4, 6 and 24 h during PCA administration.
Pain scores decreased significantly with time in both groups (P < 0.05), but were lower in group M than in group T at 1, 2 and 4 h (P < 0.05). Sedation scores increased with time in both groups (P < 0.05). However there were no significant differences in sedation scores between two groups at any study period, but nausea scores were higher in M group at 4, 6 and 24 h (P < 0.05).
Intravenous patient-controlled tramadol is an alternative to patient-controlled morphine for postoperative pain relief in children after tonsillectomy. Morphine gave better postoperative pain relief, but was associated with a higher incidence of nausea than tramadol.
曲马多是术后疼痛管理中其他阿片类药物的替代品。本前瞻性、随机、双盲研究旨在比较儿童扁桃体切除术后患者自控曲马多与患者自控吗啡的镇痛效果。
在一项双盲随机研究中，60例患者被随机分配接受曲马多（T组）或吗啡（M组）的患者自控镇痛（PCA）。手术完成并止血后，给予标准化负荷剂量（M组为0.1mg·kg⁻¹，T组为1mg·kg⁻¹）。此后，儿童通过PCA装置自行给予推注剂量（吗啡0.02mg·kg⁻¹或曲马多0.2mg·kg⁻¹），锁定时间为10分钟，无时间限制。在PCA给药期间的5、15、30分钟以及1、2、4、6和24小时记录疼痛、镇静、恶心评分以及推注和总PCA剂量、血流动力学参数和副作用。
两组疼痛评分均随时间显著降低（P<0.05），但在1、2和4小时时，M组低于T组（P<0.05）。两组镇静评分均随时间增加（P<0.05）。然而，在任何研究期间，两组镇静评分均无显著差异，但M组在4、6和24小时时恶心评分较高（P<0.05）。
静脉注射患者自控曲马多是儿童扁桃体切除术后替代患者自控吗啡进行术后疼痛缓解的一种选择。吗啡术后镇痛效果更好，但与曲马多相比，恶心发生率更高。
