二次剖宫产术后患者自控静脉注射曲马多与患者自控静脉注射氢吗啡酮用于镇痛的比较：一项比较镇痛、抗焦虑和抗抑郁效果的随机对照试验
Patient-controlled intravenous tramadol versus patient-controlled intravenous hydromorphone for analgesia after secondary cesarean delivery: a randomized controlled trial to compare analgesic, anti-anxiety and anti-depression effects.
作者信息
Duan Guangyou, Bao Xiaohang, Yang Guiying, Peng Jing, Wu Zhuoxi, Zhao Peng, Zuo Zhiyi, Li Hong
机构信息
Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA.
出版信息
J Pain Res. 2018 Dec 18;12:49-59. doi: 10.2147/JPR.S184782. eCollection 2019.
INTRODUCTION
This study aimed to compare the postoperative analgesic effects of tramadol and hydromorphone for secondary cesarean delivery (CD) as well as their anti-anxiety and anti-depression properties.
METHODS
A total of 106 patients receiving secondary CD under spinal anesthesia were randomly allocated to the tramadol group (n=53) and the hydromorphone group (n=53). Each group received patient-controlled intravenous analgesia using flurbiprofen 4 mg/kg combined with tramadol (4 mg/kg) or hydromorphone (0.04 mg/kg) immediately after the surgery. Postoperative pain numerical rating scale (NRS) for incision and visceral pain, hospital anxiety and depression scale (HADS), early walking time and length of hospital stay were assessed.
RESULTS
Patients in the tramadol and hydromorphone groups exhibited equivalent incision pain NRS at different time points (>0.05). Visceral pain in the tramadol group was higher than that in the hydromorphone group at postoperative 4 hours (2.9 [1.2] vs 2.3 [1.4], =0.011) and 8 hours (2.4 [1.1] vs 1.8 [1.1], =0.028). One week after the surgery, the patients in the tramadol group, as compared to the hydromorphone group, had lower anxiety scores (1.9 [3.5] vs 3.6 [4.1], =0.033) and depression scores (0.8 [1.3] vs 2.7 [4.1], =0.023). In addition, early walking time (25.3 [7.0] hours vs 29.3 [9.6] hours, =0.016) and length of hospital stay (2.9 [0.8] days vs 3.3 [0.8] days, = 0.008) after the surgery in the tramadol group were less than those in the hydromorphone group.
CONCLUSION
Postoperative intravenous analgesia with tramadol or hydromorphone for secondary CD provides comparable analgesic effects on incision pain. Tramadol is less effective in controlling visceral pain compared to hydromorphone. However, tramadol can help to alleviate anxiety and depression in the early postpartum period, improve patients' early mobilization and shorten their hospital stay.
CLINICAL TRIAL NUMBER AND REGISTRY URL
No: ChiCTR-IIR-17011043; URL: www.chictr.org.cn.
引言
本研究旨在比较曲马多和氢吗啡酮用于二次剖宫产术后的镇痛效果及其抗焦虑和抗抑郁特性。
方法
106例在脊髓麻醉下接受二次剖宫产的患者被随机分为曲马多组（n = 53）和氢吗啡酮组（n = 53）。每组在手术后立即使用氟比洛芬4mg/kg联合曲马多（4mg/kg）或氢吗啡酮（0.04mg/kg）进行患者自控静脉镇痛。评估术后切口和内脏疼痛的数字评分量表（NRS）、医院焦虑抑郁量表（HADS）、早期步行时间和住院时间。
结果
曲马多组和氢吗啡酮组患者在不同时间点的切口疼痛NRS相当（>0.05）。曲马多组术后4小时（2.9[1.2]对2.3[1.4]，P = 0.011）和8小时（2.4[1.1]对1.8[1.1]，P = 0.028）的内脏疼痛高于氢吗啡酮组。术后1周，曲马多组患者的焦虑评分（1.9[3.5]对3.6[4.1]，P = 0.033）和抑郁评分（0.8[1.3]对2.7[4.1]，P = 0.023）低于氢吗啡酮组。此外，曲马多组术后早期步行时间（25.3[7.0]小时对29.3[9.6]小时，P = 0.016）和住院时间（2.9[0.8]天对3.3[0.8]天，P = 0.008）少于氢吗啡酮组。
结论
曲马多或氢吗啡酮用于二次剖宫产术后静脉镇痛对切口疼痛的镇痛效果相当。与氢吗啡酮相比，曲马多控制内脏疼痛的效果较差。然而，曲马多有助于缓解产后早期的焦虑和抑郁，促进患者早期活动并缩短住院时间。
临床试验编号和注册网址
编号：ChiCTR-IIR-17011043；网址：www.chictr.org.cn。
Zotero 插件