Hadi M A, Kamaruljan H Shamsul, Saedah A, Abdullah N M Nik
Department of Anaesthesiology and Critical Care, International Islamic University Malaysia, Jalan Bukit Istana, 25200 Bandar Indera Mahkota, Kuantan, Pahang.
Med J Malaysia. 2006 Dec;61(5):570-6.
The success of major surgery depends partly on providing effective post-operative pain relief, which can be commonly achieved by morphine administration via patient- controlled analgesic (PCA) system. Alternatively, tramadol which is a weak opioid analgesic, can be used for post operative pain relief. The purpose of this study was to evaluate the effectiveness of intravenous PCA tramadol in comparison with PCA morphine in term of analgesic properties, sedation and side effects. A randomized, double-blinded study was conducted on 160 ASA I and II patients who underwent major operations. Eighty of them received a loading dose of intravenous morphine 0.1 mg/kg followed by PCA morphine bolus of 1 mg (1 mg/ml) as required, while the other 80 patients received a loading dose of 2.5 mg/kg of intravenous tramadol followed by PCA infusion of 10 mg (10 mg/ml) as required. Patients were monitored for pain, sedation and side effects as well as respiratory rate, nausea, vomiting, pruritus, blood pressure and pulse rate. Patients were evaluated 30 minutes, 4 hours, 24 hours and 48 hours post operation. There were no differences in the demographic data between the two groups (p > 0.05). The overall mean pain score in tramadol group was 0.70 +/- 0.60 as compared to 0.75 +/- 0.67 for morphine group. The mean pain score for tramadol and morphine groups at 30 minutes, 4 hours, 24 hours and 48 hours post operation were 1.32 +/- 0.79, 104 +/- 0.79, 0.35 +/- 0.48, 0.09 +/- 0.33 and 1.35 +/- 0.99, 1.14 +/- 0.81, 0.40 +/- 0.54, 0.10 +/- 0.34 respectively. The overall mean sedation score in tramadol and morphine group was 0.39 +/- 0.44 as compared to 0.35 +/- 0.43 for morphine group. The mean sedation score for tramadol and morphine group at 30 minutes, 4 hours, 24 hours and 48 hours post operation were 0.90 +/- 0.74, 0.56 +/- 0.59, 0.075 +/- 0.27, 0.025 +/- 0.16 and 0.84 +/- 0.70, 0.46 +/- 0.64, 0.08 +/- 0.27, 0.01 +/- 0.11 respectively. There was no significant difference in the overall mean pain and sedation score between the two groups as well as for each duration assessed (p > 0.05). There were also no significant differences between the two groups with regard to the blood pressure and heart rate. The incidence of nausea, vomiting and pruritus were the same in the two groups. This study indicates that PCA tramadol is as equally effective as PCA morphine control following major surgery. The incidences of sedation, nausea or pruritus were the same in the two groups.
大手术的成功部分取决于术后有效的疼痛缓解，这通常可通过患者自控镇痛（PCA）系统给予吗啡来实现。另外，曲马多作为一种弱阿片类镇痛药，可用于术后疼痛缓解。本研究的目的是比较静脉注射PCA曲马多与PCA吗啡在镇痛特性、镇静作用及副作用方面的有效性。对160例接受大手术的美国麻醉医师协会（ASA）I级和II级患者进行了一项随机双盲研究。其中80例患者先静脉注射负荷剂量的吗啡0.1mg/kg，随后根据需要给予PCA吗啡推注剂量1mg（1mg/ml）；另外80例患者先静脉注射负荷剂量的曲马多2.5mg/kg，随后根据需要给予PCA输注剂量10mg（10mg/ml）。对患者的疼痛、镇静及副作用以及呼吸频率、恶心、呕吐、瘙痒、血压和脉搏率进行监测。在术后30分钟、4小时、24小时和48小时对患者进行评估。两组患者的人口统计学数据无差异（p>0.05）。曲马多组的总体平均疼痛评分是0.70±0.60，而吗啡组为0.75±0.67。曲马多组和吗啡组在术后30分钟、4小时、24小时和48小时的平均疼痛评分分别为1.32±0.79、1.04±0.79、0.35±0.48、0.09±0.33和1.35±0.99、1.14±0.81、0.40±0.54、0.10±0.34。曲马多组和吗啡组的总体平均镇静评分是0.39±0.44，而吗啡组为0.35±0.43。曲马多组和吗啡组在术后30分钟、4小时、24小时和48小时的平均镇静评分分别为0.90±0.74、0.56±0.59、0.075±0.27、0.025±0.16和0.84±0.70、0.46±0.64、0.08±0.27、0.01±0.11。两组之间的总体平均疼痛和镇静评分以及各评估时间段均无显著差异（p>0.05）。两组之间的血压和心率也无显著差异。两组恶心、呕吐和瘙痒的发生率相同。本研究表明，大手术后PCA曲马多在控制疼痛方面与PCA吗啡同样有效。两组的镇静、恶心或瘙痒发生率相同。
