Department of Anesthesiology, Affiliated Nanjing Maternal and Child Health Care Hospital, Nanjing Medical University, No. 123, Tianfei Xiang, Mochou Road, Nanjing 210004, China.
Pharmacol Rep. 2009 Nov-Dec;61(6):1198-205. doi: 10.1016/s1734-1140(09)70184-7.
This double blind, randomized, controlled trial investigated whether a single preoperative intravenous (iv) dose of tramadol (100 mg) given 30 min before abdominal hysterectomy resulted in improved analgesic efficacy, reduced postoperative morphine patient-controlled analgesia (PCA) use and reduced side effects when combined with a postoperative small-dose tramadol infusion. Two-hundred twenty-four patients undergoing elective abdominal hysterectomy were randomly allocated to one of two groups: the tramadol group (n = 113) received iv tramadol (100 mg) 30 min before surgery, and the control group (n = 111) received an equivalent volume of normal saline. Upon awakening from general anesthesia, all patients received a loading dose of 0.5 mg/kg of tramadol and a small-dose infusion of tramadol (0.1 mg/kg/h) for 48 h. In addition, all patients were connected to morphine PCA delivering a morphine bolus of 0.02 mg/kg with a 6-min lock-out. Data on pain intensity at rest and during movement, morphine consumption, side-effects and overall patient satisfaction were recorded. A total of 189 patients completed the study. Preemptive tramadol was associated with superior analgesia at rest and with movement in the first 24 h after surgery (p < 0.01), a longer interval to first morphine PCA request (p = 0.019), and reduced morphine PCA use (p = 0.017). The tramadol group had reduced nausea (p = 0.015), dizziness (p = 0.001) and drowsiness (p = 0.0001), while other side-effects were similar. In conclusion, a single dose of iv tramadol (100 mg) 30 min prior to abdominal hysterectomy improves analgesia, and reduces morphine PCA requirements, nausea, dizziness and drowsiness when combined with a postoperative small-dose tramadol infusion and morphine PCA when compared to the same analgesic regimen that omitted the preemptive tramadol.
这项双盲、随机、对照试验研究了在接受择期腹部子宫切除术的患者中，术前 30 分钟静脉（iv）给予单次 100 毫克曲马多是否能改善镇痛效果、减少术后吗啡患者自控镇痛（PCA）的使用以及减少术后小剂量曲马多输注时的副作用。将 224 例择期行腹部子宫切除术的患者随机分为两组：曲马多组（n=113）在手术前 30 分钟给予 iv 曲马多（100 mg），对照组（n=111）给予等量生理盐水。全身麻醉苏醒后，所有患者均给予负荷剂量 0.5mg/kg 曲马多和 48 小时小剂量曲马多输注（0.1mg/kg/h）。此外，所有患者均连接吗啡 PCA，给予 0.02mg/kg 的吗啡推注，锁定时间为 6 分钟。记录疼痛强度（静息时和运动时）、吗啡用量、副作用和整体患者满意度。共有 189 例患者完成了研究。预防性曲马多与静息时和手术后 24 小时内运动时的镇痛效果更好（p<0.01），首次请求吗啡 PCA 的时间间隔更长（p=0.019），且吗啡 PCA 用量减少（p=0.017）。曲马多组恶心（p=0.015）、头晕（p=0.001）和嗜睡（p=0.0001）的发生率降低，而其他副作用相似。总之，与省略预防性曲马多的相同镇痛方案相比，腹部子宫切除术前 30 分钟静脉给予 100 毫克曲马多可改善镇痛效果，并减少术后小剂量曲马多输注和吗啡 PCA 时的吗啡 PCA 需求、恶心、头晕和嗜睡。
