Ruetzler Kurt, Blome Constance J, Nabecker Sabine, Makarova Natalya, Fischer Henrik, Rinoesl Harald, Goliasch Georg, Sessler Daniel I, Koinig Herbert
Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria,
J Anesth. 2014 Aug;28(4):580-6. doi: 10.1007/s00540-013-1770-x. Epub 2013 Dec 28.
Cardiac surgery and sternotomy are procedures accompanied by substantial postoperative pain which is challenging to treat. In general, intravenous (IV) opioids are used in the immediate postoperative phase, followed by oral opioids. Oral opioids are easier to use and generally less expensive. Our goal was thus to determine whether a new opioid preparation provides adequate analgesia after sternotomy. In particular, we tested the primary hypothesis that total opioid use (in morphine equivalents) is not greater with oral opioid compared with patient-controlled IV morphine. Our secondary hypothesis was that analgesic efficacy is similar with oral and IV opioids.
A total of 51 patients having elective cardiac surgery were enrolled in this study. After rapid postoperative respiratory weaning, the patients were randomised into one of two groups receiving different types of analgesia: oral Targin (a combination of oxycodone-hydrochloride and the opioid antagonist naloxone hydrochloride-dihydrate) or patient-controlled IV morphine. Pain score (visual analogue scale), sedation (Ramsey score), respiratory rate and side effects were assessed at 3, 5, 7, 9 and 11 h after surgery, and every 6 h throughout the third postoperative evening.
The total opioid dose in morphine equivalent doses was significantly lower with oral opioid than with IV morphine (adjusted geometric means [95 % confidence interval]: 34 [29; 38] vs. 69 [61; 78] mg, respectively). Pain scores were similar in each group.
Analgesic quality was comparable with oral and IV opioids, suggesting that postoperative pain even after very painful procedures can be sufficiently managed with oral opioids.
心脏手术和胸骨切开术会带来严重的术后疼痛，治疗颇具挑战性。一般而言，术后即刻使用静脉注射（IV）阿片类药物，随后使用口服阿片类药物。口服阿片类药物使用更便捷，且通常成本更低。因此，我们的目标是确定一种新型阿片类制剂在胸骨切开术后是否能提供足够的镇痛效果。具体而言，我们检验了主要假设，即与患者自控静脉注射吗啡相比，口服阿片类药物的总阿片类药物用量（以吗啡当量计）并不更高。我们的次要假设是口服和静脉注射阿片类药物的镇痛效果相似。
本研究共纳入51例行择期心脏手术的患者。术后快速实现呼吸脱机后，将患者随机分为两组，接受不同类型的镇痛治疗：口服Targin（盐酸羟考酮与阿片类拮抗剂二水合盐酸纳洛酮的组合）或患者自控静脉注射吗啡。在术后3、5、7、9和11小时以及术后第三个晚上每6小时评估疼痛评分（视觉模拟量表）、镇静程度（拉姆齐评分）、呼吸频率和副作用。
口服阿片类药物的吗啡当量总阿片类药物剂量显著低于静脉注射吗啡（调整后的几何均数[95%置信区间]：分别为34[29；38]mg和69[61；78]mg）。每组的疼痛评分相似。
口服和静脉注射阿片类药物的镇痛质量相当，这表明即使是在非常疼痛的手术后，口服阿片类药物也能充分控制术后疼痛。
