Udelsmann Artur, Maciel Fernanda Gardini, Servian Derli Conceição Munhoz, Reis Eder, de Azevedo Teresinha Maria, Melo Marcos de Simone
Anesthesiology Department, Universidade de Campinas, Campinas, SP, Brazil.
Rev Bras Anestesiol. 2011 Nov-Dec;61(6):695-701. doi: 10.1016/S0034-7094(11)70078-2.
Pain is an aggravating factor in postoperative morbidity and mortality especially in large size surgeries. Methods to effectively fend pain collide with elevated costs and for this reason they are not accessible in every service. The option would be the use of an opioid with long half-life, such as methadone. The objective of the present study was to compare the requirements of postoperative analgesia in patients who received methadone, morphine, or placebo during anesthetic induction, besides the prevalence of postoperative nausea and vomiting.
Fifty-five patients scheduled for cardiac surgery were divided into three groups and they received during anesthetic induction 20mg of methadone, 20mg of morphine, or placebo. At the end of surgery, patients were transferred to the ICU where the following parameters were evaluated: duration of anesthesia, time until extubation, time until the need of the first analgesic, number of doses required in 24 hours, assessment of analgesia by the patient, and prevalence of nausea/vomiting.
Differences in the duration of anesthesia and time until extubation were not observed. The first dose of analgesic in patients who received methadone was administered later than in patients in the other two groups. The need of analgesics in the methadone group was lower, quality of analgesia was better, and prevalence of nausea and vomiting was also lower.
Methadone during anesthetic induction was effective for analgesia in large size surgeries. Lower incidence of nausea and vomiting was observed in the methadone group and therefore it is a low cost option available among us that should be stimulated.
疼痛是术后发病和死亡的一个加重因素，尤其是在大型手术中。有效缓解疼痛的方法与成本增加相冲突，因此并非在每个医疗服务中都能采用。选择使用半衰期长的阿片类药物，如美沙酮，可能是一种解决方案。本研究的目的是比较在麻醉诱导期间接受美沙酮、吗啡或安慰剂的患者术后镇痛需求，以及术后恶心和呕吐的发生率。
55例计划进行心脏手术的患者被分为三组，在麻醉诱导期间分别接受20mg美沙酮、20mg吗啡或安慰剂。手术结束后，患者被转至重症监护病房（ICU），评估以下参数：麻醉持续时间、拔管时间、首次需要镇痛的时间、24小时内所需剂量、患者对镇痛的评估以及恶心/呕吐的发生率。
未观察到麻醉持续时间和拔管时间的差异。接受美沙酮的患者首次给予镇痛剂的时间比其他两组患者晚。美沙酮组的镇痛需求较低，镇痛质量较好，恶心和呕吐的发生率也较低。
麻醉诱导期间使用美沙酮对大型手术镇痛有效。美沙酮组恶心和呕吐的发生率较低，因此它是一种我们可采用的低成本选择，应予以推广。
