Zavareh Sayyed Morteza Heidari Tabaei, Kashefi Parviz, Saghaei Mahmmoud, Emami Hale
Department of Anesthesiology and critical care research center, Isfahan University of Medical sciences, Isfahan, Iran.
Adv Biomed Res. 2013 Mar 6;2:12. doi: 10.4103/2277-9175.107964. Print 2013.
Considering that protocols of postoperative pain management would be planned regarding the facilities of each center or region and the importance of its proper management to reduce its related complication and improve patient's satisfaction, in this study we compared the effect of orally administrated tramadol and acetaminophen-codeine in this regard.
In this prospective randomized double-blind clinical trial, 136 (68 in tramadol and 68 in acetaminophen codeine groups) ASA I and II patients scheduled for open cholecystectomy under general anaesthesia were enrolled. They randomly allocated to receive oral tramadol (50 mg capsule) or acetaminophen-codeine (325/10 mg) 1 hour before surgery. After surgery they evaluated for postoperative pain using VAS score, analgesic consumption and vomiting.
Mean of postoperative pain score during 24 hours after surgery was 2.1 ± 1.0 and 3.8 ± 2.0 in tramadol and acetaminophen-codeine groups, respectively (P < 0.05). Mean of analgesic consumption (morphine) during 24 hours after surgery was 6.2 ± 4.4 mg and 12.9 ± 5.7 mg in tramadol and acetaminophen-codeine groups, respectively (P < 0.05). Mean of vomiting during 24 hours after surgery was 1.2 ±0.9 and 0.4 ± 0.5 in tramadol and acetaminophen-codeine groups, respectively (P < 0.05).
The findings of current study indicated that in lower dose of tramadol (50 mg) and acetaminophen/codeine (325 mg/10 mg) the analgesic effect of tramadol is better and its side effects are higher than acetaminophen/codeine, which limit its use for mentioned purpose. It seems that administration of each of studied agents it depends on patients' tolerance and decision of the physician.
考虑到术后疼痛管理方案会根据每个中心或地区的设施情况来制定，且妥善管理对减少相关并发症及提高患者满意度至关重要，在本研究中，我们比较了口服曲马多和对乙酰氨基酚 - 可待因在这方面的效果。
在这项前瞻性随机双盲临床试验中，纳入了136例（曲马多组68例，对乙酰氨基酚 - 可待因组68例）计划在全身麻醉下行开腹胆囊切除术的ASA I级和II级患者。他们在手术前1小时被随机分配接受口服曲马多（50毫克胶囊）或对乙酰氨基酚 - 可待因（325/10毫克）。术后使用视觉模拟评分法（VAS）评估疼痛程度、镇痛药消耗量及呕吐情况。
术后24小时内，曲马多组和对乙酰氨基酚 - 可待因组的术后疼痛评分均值分别为2.1±1.0和3.8±2.0（P<0.05）。术后24小时内，曲马多组和对乙酰氨基酚 - 可待因组的镇痛药（吗啡）消耗量均值分别为6.2±4.4毫克和12.9±5.7毫克（P<0.05）。术后24小时内，曲马多组和对乙酰氨基酚 - 可待因组的呕吐均值分别为1.2±0.9和0.4±0.5（P<0.05）。
本研究结果表明，在较低剂量的曲马多（50毫克）和对乙酰氨基酚/可待因（325毫克/10毫克）下，曲马多的镇痛效果更好，但其副作用高于对乙酰氨基酚/可待因，这限制了其用于上述目的。似乎每种研究药物的使用都取决于患者的耐受性和医生的决定。
