Unlugenc H, Tetiker S, Isik G
Cukurova University, Faculty of Medicine, Department of Anesthesiology, Adana, Turkey.
Eur J Anaesthesiol. 2008 Dec;25(12):968-75. doi: 10.1017/S0265021508004663. Epub 2008 Jun 5.
We have investigated whether, after major abdominal surgery, the addition of remifentanil to tramadol for intravenous patient-controlled analgesia improved analgesia and lowered pain scores, compared to a patient-controlled analgesia containing only tramadol.
Sixty-two patients were allocated randomly to receive an intravenous patient-controlled analgesia with tramadol alone (T), or tramadol plus remifentanil (TR), in a double-blind randomized study. Whenever patients complained of pain, they were allowed to use bolus doses of tramadol (0.2 mg kg-1) or tramadol (0.2 mg kg-1) plus remifentanil (0.2 microg kg-1) mixture every 10 min without a time limit and background infusion. Discomfort, sedation, pain scores, total and bolus patient-controlled analgesia tramadol consumption, and side-effects were recorded for up to 24 h after the start of patient-controlled analgesia.
Pain scores at rest were statistically significantly lower in the TR group at 6, 12 and 24 h than in T group (P < 0.05). Pain scores at movement and patient comfort scores were also found to be significantly lower in the TR group at 2, 6, 12 and 24 h than in the T group (P < 0.05). Although the TR group consumed less tramadol, there were no statistically significant differences in the cumulative tramadol consumptions between the groups at any time. However, the number of patients requiring rescue analgesia and average supplementary doses used was significantly higher in the T group than in the TR group (P < 0.05).
After major abdominal surgery, adding remifentanil (0.2 microg kg(-1)) to tramadol (0.2 mg kg(-1)), with 10-min lockout times, for patient-controlled analgesia offered better postoperative pain relief and patient comfort, without causing any sedation or respiratory depression.
我们研究了在腹部大手术后，与仅含曲马多的静脉自控镇痛相比，在曲马多基础上加用瑞芬太尼进行静脉自控镇痛是否能改善镇痛效果并降低疼痛评分。
在一项双盲随机研究中，62例患者被随机分配接受单纯曲马多静脉自控镇痛（T组）或曲马多加瑞芬太尼静脉自控镇痛（TR组）。每当患者主诉疼痛时，允许他们每10分钟使用一次曲马多推注剂量（0.2mg/kg）或曲马多（0.2mg/kg）加瑞芬太尼（0.2μg/kg）混合剂，无时间限制且无背景输注。记录自控镇痛开始后长达24小时的不适、镇静、疼痛评分、曲马多总消耗量和推注量以及副作用。
TR组静息时的疼痛评分在6、12和24小时时统计学上显著低于T组（P<0.05）。TR组在2、6、12和24小时时运动时的疼痛评分和患者舒适度评分也显著低于T组（P<0.05）。虽然TR组曲马多消耗量较少，但两组间任何时间的曲马多累积消耗量均无统计学显著差异。然而，需要补救镇痛的患者数量和使用的平均补充剂量T组显著高于TR组（P<0.05）。
腹部大手术后，在曲马多（0.2mg/kg）基础上加用瑞芬太尼（0.2μg/kg），锁定时间为1十分钟，用于静脉自控镇痛可提供更好的术后疼痛缓解和患者舒适度，且不会引起任何镇静或呼吸抑制。
