Jabalameli Mitra, Rouholamin Safoura, Gourtanian Fatemeh
Department of Anaesthesiology and Critical Care, Alzahra General Hospital, Isfahan University of Medical Science, Isfahan, ran.
Iran J Med Sci. 2011 Sep;36(3):183-7.
The effects of different opioids on postoperative nausea and vomiting (PONV) and pain have not been conclusively determined. The aim of this study was to compare the effects of fentanyl, remifentanil or fentanyl plus morphine on the incidence of PONV and pain in women subjected to cesarean section under general anesthesia.
The study was a randomized clinical trial recruiting 96 parturients with American Society of Anesthesiologists (ASA) physical status I and II. They scheduled for cesarean section under general anesthesia using sodium thiopental, succynylcholine, and isoflurane O2/N2O 50/50 mixture. After clamping the umbilical cord, the patients were given fentanyl (2 µg/kg/h), remifentanil (0.05 µg/kg/h), or fentanyl (2 µg/kg) pulse morphine (0.1 mg/kg) intravenously. Visual analog scale for pain and nausea, frequency of PONV, meperidine and metoclopramide consumption were evaluated at recovery, and 4, 8, 12 and 24 hours after the surgery.
There was no significant difference between the three groups in terms of frequency of nausea, vomiting, and mean nausea and pain scores at any time points. None of the patients required the administration of metoclopramide. However, the mean VAS for pain in remifentanil-treated group was insignificantly more than that in fentanyl- or fentanyl plus morphine-treated group at recovery or 4 hours after the surgery. The mean mepridine consumption in remifentanil-treated group was significantly (P=0.001) more than that in fentanyl- or fentanyl plus morphine-treated group in 24 hours after the surgery respectively. There was no significant difference in hemodynamic parameters of the three groups in all measurements after the surgery.
The findings of this study showed that early postoperative analgesia was better with fentanyl, and postoperative meperidine consumption was significantly less with fentanyl than with remifentanil or combined fentayl and morphine.
不同阿片类药物对术后恶心呕吐（PONV）和疼痛的影响尚未最终确定。本研究的目的是比较芬太尼、瑞芬太尼或芬太尼加吗啡对全身麻醉下剖宫产妇女PONV发生率和疼痛的影响。
本研究为一项随机临床试验，招募了96例美国麻醉医师协会（ASA）身体状况为I级和II级的产妇。她们计划在全身麻醉下使用硫喷妥钠、琥珀酰胆碱和异氟烷O2/N2O 50/50混合物进行剖宫产。钳夹脐带后，患者静脉注射芬太尼（2μg/kg/h）、瑞芬太尼（0.05μg/kg/h）或芬太尼（2μg/kg）加脉冲吗啡（0.1mg/kg）。在恢复时以及术后4、8、12和24小时评估疼痛和恶心的视觉模拟量表、PONV频率、哌替啶和甲氧氯普胺的消耗量。
三组在任何时间点的恶心、呕吐频率以及平均恶心和疼痛评分方面均无显著差异。没有患者需要使用甲氧氯普胺。然而，瑞芬太尼治疗组在恢复时或术后4小时的疼痛平均视觉模拟量表（VAS）略高于芬太尼或芬太尼加吗啡治疗组。瑞芬太尼治疗组术后24小时的平均哌替啶消耗量分别显著高于芬太尼或芬太尼加吗啡治疗组（P=0.001）。术后所有测量中三组的血流动力学参数无显著差异。
本研究结果表明，芬太尼术后早期镇痛效果更好，且芬太尼术后哌替啶消耗量显著低于瑞芬太尼或芬太尼与吗啡联合使用。
