甲氧氯普胺可提高曲马多 PCA 的质量，与吗啡 PCA 相比无明显差异：一项前瞻性、随机、双盲临床比较。

Metoclopramide improves the quality of tramadol PCA indistinguishable to morphine PCA: a prospective, randomized, double blind clinical comparison.

机构信息

Advanced Aesthetics Surgery Center, Orlando, Florida, USA.

出版信息

Pain Med. 2013 Sep;14(9):1426-34. doi: 10.1111/pme.12166. Epub 2013 Jun 21.

DOI:10.1111/pme.12166

PMID:23789747

Abstract

OBJECTIVE

Multimodal analgesia has been effectively used in postoperative pain control. Tramadol can be considered "multimodal" because it has two main mechanisms of action, an opioid agonist and a reuptake inhibitor of norepinephrine and serotonin. Tramadol is not as commonly used as morphine due to the increased incidence of postoperative nausea and vomiting (PONV). As metoclopramide is an antiemetic and an analgesic, it was hypothesized that when added to reduce PONV, metoclopromide may enhance the multimodal feature of tramadol by the analgesic property of metoclopramide. Therefore, the effectiveness of postoperative patient-controlled analgesia (PCA) with morphine was compared against PCA with combination of tramadol and metoclopramide.

DESIGN

A prospective, randomized, double blind clinical trial.

SETTING

Academic pain service of a university hospital.

SUBJECTS

Sixty patients undergoing elective total knee arthroplasty with general anesthesia.

METHODS

Sixty patients were randomly divided into Group M and Group T. In a double-blinded fashion, Group M received intraoperative 0.2 mg/kg morphine and postoperative PCA with 1 mg morphine per bolus, whereas Group T received intraoperative tramadol 2.5 mg/kg and postoperative PCA with 20 mg tramadol plus 1 mg metoclopramide per bolus. Lockout interval was 5 minutes in both groups. Pain scale, satisfaction rate, analgesic consumption, PCA demand, and side effects were recorded by a blind investigator.

RESULTS

These two groups displayed no statistically significant difference between the items and variables evaluated.

CONCLUSIONS

This combination provides analgesia equivalent to that of morphine and can be used as an alternative to morphine PCA.

摘要

目的

多模式镇痛已被有效地用于术后疼痛控制。曲马多可以被认为是“多模式”的，因为它有两种主要的作用机制，阿片激动剂和去甲肾上腺素和 5-羟色胺再摄取抑制剂。由于术后恶心和呕吐（PONV）的发生率增加，曲马多不如吗啡常用。由于甲氧氯普胺是一种止吐药和镇痛药，因此假设当添加它以减少 PONV 时，甲氧氯普胺可能通过甲氧氯普胺的镇痛特性增强曲马多的多模式特征。因此，比较了吗啡用于术后患者自控镇痛（PCA）的效果与曲马多和甲氧氯普胺联合用于 PCA 的效果。

设计

前瞻性、随机、双盲临床试验。

地点

一所大学医院的学术疼痛服务。

受试者

60 例接受全身麻醉下择期全膝关节置换术的患者。

方法

60 例患者随机分为 M 组和 T 组。在双盲状态下，M 组接受术中 0.2mg/kg 吗啡和术后 PCA 用 1mg 吗啡每剂，而 T 组接受术中曲马多 2.5mg/kg 和术后 PCA 用 20mg 曲马多加 1mg 甲氧氯普胺每剂。两组的锁定间隔均为 5 分钟。盲法调查员记录疼痛评分、满意度、镇痛消耗、PCA 需求和副作用。