Gómez-Vázquez María Elena, Hernández-Salazar Eduardo, Novelo-Otañez Jorge Daniel, Cabrera-Pivaral Carlos Enrique, Dávalos-Rodríguez Ingrid Patricia, Salazar-Páramo Mario
Departamento de Anestesiología, Hospital General de Zona No. 89, IMSS Guadalajara, Jalisco, México.
Cir Cir. 2012 Jan-Feb;80(1):56-62.
Postoperative pain is the main symptom following a surgical event and is related to an inflammatory process involving cytokine secretion. This type of pain is usually treated with opioids such as morphine, whose analgesic efficacy is well known. However, it is unknown when compared with ketorolac in measuring proinflammatory cytokine levels. The aim of this study was to determine the postoperative analgesic effect with endovenous morphine on proinflammatory cytokine levels in patients who underwent laparoscopic choleystectomy.
We studied 40 patients who underwent laparoscopic cholecystectomy. Patients were randomized to receive morphine (0.05 mg/kg) or ketorolac (0.2 mg/kg) IV during gallbladder extraction and after the surgical event at the following dose: morphine (0.15 mg/kg) or ketorolac (0.7 mg/kg) for 40 min. Clinical evaluations included were hemodynamic, analgesic with visual analogue scale, and sedation (Ramsay scale). IL-1β and TNF-a were measured pre- and postoperatively and after 12 h. Safety profile was evaluated with hemodynamic constants. Statistical analysis was carried out using Mann-Whitney U test and Fisher exact test.
TNF-a was increased significantly in the immediate postoperative period and after 12 h in the morphine group. IL-1β was not detected preoperatively, in the immediate postoperative period and 12 h after surgery the levels were similar in both groups. The main adverse event was respiratory depression, which occurred in the morphine group.
Proinflammatory cytokines were increased after surgery, particularly TNF-a in the group receiving morphine. The use of morphine is safe postoperatively.
术后疼痛是手术事件后的主要症状，与涉及细胞因子分泌的炎症过程有关。这类疼痛通常用吗啡等阿片类药物治疗，其镇痛效果众所周知。然而，与酮咯酸相比，在测量促炎细胞因子水平时情况尚不清楚。本研究的目的是确定静脉注射吗啡对接受腹腔镜胆囊切除术患者促炎细胞因子水平的术后镇痛效果。
我们研究了40例接受腹腔镜胆囊切除术的患者。患者在胆囊切除术中及术后随机接受静脉注射吗啡（0.05mg/kg）或酮咯酸（0.2mg/kg），随后以如下剂量给药：吗啡（0.15mg/kg）或酮咯酸（0.7mg/kg），持续40分钟。临床评估包括血流动力学、视觉模拟评分法评估的镇痛效果以及镇静情况（拉姆齐评分）。在术前、术后及术后12小时测量白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）。通过血流动力学常数评估安全性。使用曼-惠特尼U检验和费舍尔精确检验进行统计分析。
吗啡组术后即刻及术后12小时TNF-α显著升高。术前未检测到IL-1β，术后即刻及术后12小时两组水平相似。主要不良事件是呼吸抑制，发生在吗啡组。
术后促炎细胞因子增加，尤其是接受吗啡治疗的组中TNF-α升高。术后使用吗啡是安全的。
