Hinrichs M, Weyland A, Bantel C
Universitätsklinik für Anästhesiologie/Intensivmedizin/Notfallmedizin/Schmerztherapie, Klinikum Oldenburg AöR, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland.
Schmerz. 2017 Aug;31(4):345-352. doi: 10.1007/s00482-017-0197-y.
In many European countries and particularly in Germany, piritramide is the first choice opioid analgesic for the management of postoperative and posttraumatic pain.
The aim of this study was to review the pharmacological properties of piritramide and to evaluate whether these result in any clinical advantages with respect to effectiveness, safety and side effect profile compared to other strong opioids.
A systematic literature search was conducted in PubMed and Google Scholar and 27 articles published between 1961 and 2015 were retrieved and included in this review.
Piritramide is a strong opioid that can only be administered parenterally. After intravenous injection it is effective after 17 min with pain relief lasting for up to 6 h. It is metabolized in the liver to inactive compounds, which is advantageous compared to morphine where active metabolites can accumulate in patients with renal failure. Piritramide is highly lipophilic resulting in a long context-sensitive half-life, making it unsuitable for continuous infusions. Studies further suggest that the side effect profile of piritramide is comparable to morphine.
So far there is little evidence to support the widespread use of piritramide as first-line opioid analgesic for postoperative pain management in Germany. Especially lacking are in-depth studies about its mechanisms of action, receptor pharmacology, dose-response relationships and clinical dosing regimens. It is therefore questionable why piritramide is given priority.
在许多欧洲国家，尤其是德国，匹利卡明是用于治疗术后和创伤后疼痛的首选阿片类镇痛药。
本研究旨在综述匹利卡明的药理特性，并评估与其他强效阿片类药物相比，其在有效性、安全性和副作用方面是否具有临床优势。
在PubMed和谷歌学术上进行了系统的文献检索，检索并纳入了1961年至2015年间发表的27篇文章进行综述。
匹利卡明是一种强效阿片类药物，只能胃肠外给药。静脉注射后17分钟起效，镇痛效果可持续长达6小时。它在肝脏中代谢为无活性的化合物，这与吗啡相比具有优势，吗啡的活性代谢产物可在肾衰竭患者体内蓄积。匹利卡明具有高度脂溶性，导致其上下文敏感半衰期较长，因此不适合持续输注。研究进一步表明，匹利卡明的副作用与吗啡相当。
到目前为止，几乎没有证据支持在德国广泛使用匹利卡明作为术后疼痛管理的一线阿片类镇痛药。尤其缺乏关于其作用机制、受体药理学、剂量反应关系和临床给药方案的深入研究。因此，匹利卡明为何被优先使用值得质疑。
