曲马多联合布托啡诺对重复剖宫产术后宫缩痛的镇痛效果：一项随机、对照、双盲研究。
The analgesic effect of tramadol combined with butorphanol on uterine cramping pain after repeat caesarean section: a randomized, controlled, double-blind study.
机构信息
Department of Anesthesiology, General Hospital of Central Theater Command, Wuhan, China.
Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
J Anesth. 2020 Dec;34(6):825-833. doi: 10.1007/s00540-020-02820-9. Epub 2020 Jul 5.
PURPOSE
This study aimed to explore the effect of patient-controlled intravenous analgesia (PCIA) using tramadol combined with butorphanol on uterine cramping pain in women undergoing repeat caesarean section.
METHODS
A total of 126 patients, who were scheduled to undergo repeat caesarean section under spinal anesthesia, were included. PCIA using tramadol combined with butorphanol or sufentanil was randomly performed for postoperative pain control. Postoperative uterine cramping pain and wound pain within 48 h after surgery were evaluated. Postoperative analgesic consumption, early activity time, and length of hospital stay were also recorded and analyzed.
RESULTS
Uterine cramping pain intensity in women undergoing repeat caesarean section was significantly higher compared with their wound pain (P < 0.05). The mean visual analog scale (VAS) score for uterine cramping pain in the tramadol-butorphanol group was significantly lower than that in the sufentanil group at rest, and at 6 h and 12 h after surgery. VAS scores for uterine cramping pain during movement at 6 h, 12 h, and 24 h after surgery in the tramadol-butorphanol group were also significantly lower than that in sufentanil group (P < 0.05). There was no significant difference in VAS score for wound pain at the different time points between the tramadol-butorphanol and sufentanil groups (P > 0.05). Patient-controlled intravenous analgesia with tramadol accelerated early rehabilitation and decreased the length of hospital stay (P < 0.05).
CONCLUSION
PCIA using tramadol combined with butorphanol provided a better analgesic effect and accelerated postoperative rehabilitation compared with sufentanil, and may be an optimal analgesic strategy for women undergoing repeat caesarean section.
CLINICAL TRIAL REGISTRATION
The trial was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn ) with ID: ChiCTR-1800014986.
目的
本研究旨在探讨曲马多联合布托啡诺用于静脉自控镇痛（PCIA）对接受再次剖宫产术患者子宫痉挛性疼痛的影响。
方法
本研究共纳入 126 例行椎管内麻醉下再次剖宫产术的患者。术后采用曲马多联合布托啡诺或舒芬太尼 PCIA 进行镇痛。评估术后 48h 内子宫痉挛性疼痛和切口疼痛。记录并分析术后镇痛药物消耗量、早期活动时间和住院时间。
结果
与切口疼痛相比，再次剖宫产术患者的子宫痉挛性疼痛强度明显更高（P<0.05）。在静息状态下、术后 6h 和 12h，曲马多-布托啡诺组的平均视觉模拟评分（VAS）评分均显著低于舒芬太尼组；术后 6h、12h 和 24h 活动时的 VAS 评分也显著低于舒芬太尼组（P<0.05）。曲马多-布托啡诺组在不同时间点的切口 VAS 评分均无显著差异（P>0.05）。曲马多联合布托啡诺 PCIA 加速了早期康复并缩短了住院时间（P<0.05）。
结论
与舒芬太尼相比，曲马多联合布托啡诺用于 PCIA 可提供更好的镇痛效果，并加速术后康复，可能是再次剖宫产术患者的理想镇痛策略。
临床试验注册
该试验在中国临床试验注册中心（ www.chictr.org.cn ）注册，注册号：ChiCTR-1800014986。
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