Shin Hye Won, Ju Bum Jun, Jang Yoo Kyung, You Hae Seun, Kang Hyun, Park Ji Yong
Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea.
PLoS One. 2017 Sep 27;12(9):e0184649. doi: 10.1371/journal.pone.0184649. eCollection 2017.
Tramadol, a 4-phenyl-piperidine analog of codeine, has a unique action in that it has a central opioidergic, noradrenergic, serotonergic analgesic, and peripheral local anesthetic (LA) effect. Many studies have reported contradictory findings regarding the peripheral analgesic effect of tramadol as an adjuvant to LA in brachial plexus block (BPB). This meta-analysis aimed to evaluate the effects of tramadol as an adjunct to LA in BPB during shoulder or upper extremity surgery.
We searched the PubMed, EMBASE, Cochrane, KoreaMed databases, and Google Scholar for eligible randomized controlled trials (RCTs) that compared BPB with LA alone and BPB with LA and tramadol. Primary outcomes were the effects of tramadol as an adjuvant on duration of sensory block, motor block, and analgesia. Secondary outcomes were the effects of tramadol as an adjuvant on time to onset of sensory block and motor block and on adverse effects. We performed the meta-analysis using Review Manager 5.3 software.
We identified 16 RCTs with 751 patients. BPB with tramadol prolonged the duration of sensory block (mean difference [MD], -61.5 min; 95% CI, -95.5 to -27.6; P = 0.0004), motor block (MD, -65.6 min; 95% CI, -101.5 to -29.7; P = 0.0003), and analgesia (MD, -125.5 min; 95% CI, -175.8 to -75.3; P < 0.0001) compared with BPB without tramadol. Tramadol also shortened the time to onset of sensory block (MD, 2.1 min; 95% CI, 1.1 to 3.1; P < 0.0001) and motor block (MD, 1.2 min; 95% CI, 0.2 to 2.1; P = 0.010). In subgroup analysis, the duration of sensory block, motor block, and analgesia was prolonged for BPB with tramadol 100 mg (P < 0.05) but not for BPB with tramadol 50 mg. The quality of evidence was high for duration of analgesia according to the GRADE system. Adverse effects were comparable between the studies.
In upper extremity surgery performed under BPB, use of tramadol 100 mg as an adjuvant to LA appears to prolong the duration of sensory block, motor block, and analgesia, and shorten the time to onset of sensory and motor blocks without altering adverse effects.
曲马多是一种可待因的4-苯基哌啶类似物，其作用独特，具有中枢阿片能、去甲肾上腺素能、5-羟色胺能镇痛以及外周局部麻醉（LA）作用。许多研究报告了关于曲马多作为臂丛神经阻滞（BPB）中LA辅助药物的外周镇痛效果的相互矛盾的结果。本荟萃分析旨在评估曲马多作为LA辅助药物在肩部或上肢手术BPB中的效果。
我们在PubMed、EMBASE、Cochrane、KoreaMed数据库和谷歌学术中搜索了符合条件的随机对照试验（RCT），这些试验比较了单纯LA的BPB和LA联合曲马多的BPB。主要结局是曲马多作为辅助药物对感觉阻滞、运动阻滞和镇痛持续时间的影响。次要结局是曲马多作为辅助药物对感觉阻滞和运动阻滞起效时间以及不良反应的影响。我们使用Review Manager 5.3软件进行荟萃分析。
我们确定了16项RCT，共751例患者。与未使用曲马多的BPB相比，使用曲马多的BPB延长了感觉阻滞持续时间（平均差[MD]，-61.5分钟；95%置信区间，-95.5至-27.6；P = 0.0004）、运动阻滞持续时间（MD，-65.6分钟；95%置信区间，-101.5至-29.7；P = 0.0003）和镇痛持续时间（MD，-125.5分钟；95%置信区间，-175.8至-75.3；P < 0.0001）。曲马多还缩短了感觉阻滞（MD，2.1分钟；95%置信区间，1.1至3.1；P < 0.0001）和运动阻滞（MD，1.2分钟；95%置信区间，0.2至2.1；P = 0.010）的起效时间。在亚组分析中，使用100 mg曲马多的BPB延长了感觉阻滞、运动阻滞和镇痛的持续时间（P < 0.05），但使用50 mg曲马多的BPB则未延长。根据GRADE系统，镇痛持续时间的证据质量很高。各研究之间的不良反应相当。
在BPB下进行的上肢手术中，使用100 mg曲马多作为LA的辅助药物似乎可延长感觉阻滞、运动阻滞和镇痛的持续时间，并缩短感觉和运动阻滞的起效时间，且不改变不良反应。
