Matsota Paraskevi K, Koukopoulou Ioanna C, Kalimeris Konstantinos A, Kyttari Aikaterini C, Drachtidi Kalliopi H, Kostopanagiotou Georgia G
2nd Department of Anaesthesiology, School of Medicine, National and Kapodistrian, University of Athens, "Attikon" University Hospital, Rimini 1 Str, Chaidari, Postal Code 12462, Athens, Greece.
Rom J Anaesth Intensive Care. 2020 Jul;27(1):43-51. doi: 10.2478/rjaic-2020-0005. Epub 2020 Aug 10.
Patient-controlled analgesia (PCA) with morphine is commonly used to provide analgesia following major surgery, but is not sufficient as a monotherapy strategy. This study aimed to compare the adjunctive analgesic effect of ketamine versus tramadol on postoperative analgesia provided via PCA-morphine in patients undergoing major upper abdominal surgeries.
Forty-two patients undergoing elective major upper abdominal surgery under general anesthesia were allocated to receive either ketamine (load dose of 0.5 mg kg followed by a continuous infusion of 0.12 mg kg h up to 48 postoperative hours; ketamine group, n = 21) or tramadol (load dose of 1 mg kg followed by a continuous infusion of 0.2 mg kg h up to 48 postoperative hours; tramadol group, n = 21) in addition to their standard postoperative analgesia with PCA-morphine. Postoperative data included morphine consumption, visual analog scale (VAS) scores, and side effects during the first 48 postoperative hours after PCA-morphine initiation.
There were no significant differences in patient demographic and intraoperative data between the two groups. Tramadol group had significantly less total morphine consumption during the first 48 postoperative hours (28.905 [16.504] vs 54.524 [20.846] mg [p < 0.001]) and presented significantly lower VAS scores at rest and mobilization (p < 0.05) than the ketamine group. No statistical difference was recorded between the two groups (p > 0.05) regarding postoperative cough, sedation, hallucinations, pruritus, urine retention, and postoperative nausea and vomiting. However, patients in the ketamine group reported dry mouth more frequently than patients in the tramadol group (p = 0.032).
Postoperative administration of tramadol was superior to ketamine due to significantly reduced opioid consumption and better pain scores in patients receiving PCA-morphine after major upper abdominal surgery.
吗啡患者自控镇痛（PCA）常用于大手术后的镇痛，但作为单一治疗策略并不充分。本研究旨在比较氯胺酮与曲马多对接受上腹部大手术患者通过PCA-吗啡提供的术后镇痛的辅助镇痛效果。
42例在全身麻醉下接受择期上腹部大手术的患者被分配接受氯胺酮（负荷剂量0.5mg/kg，随后持续输注0.12mg·kg⁻¹·h，持续至术后48小时；氯胺酮组，n = 21）或曲马多（负荷剂量1mg/kg，随后持续输注0.2mg·kg⁻¹·h，持续至术后48小时；曲马多组，n = 21），此外还接受PCA-吗啡标准术后镇痛。术后数据包括PCA-吗啡开始后前48小时内的吗啡消耗量、视觉模拟评分（VAS）以及副作用。
两组患者的人口统计学和术中数据无显著差异。曲马多组在术后前48小时内的总吗啡消耗量显著较少（28.905[16.504]对54.524[20.846]mg[p < 0.001]），且静息和活动时的VAS评分显著低于氯胺酮组（p < 0.05）。两组在术后咳嗽、镇静、幻觉、瘙痒、尿潴留以及术后恶心和呕吐方面无统计学差异（p > 0.05）。然而，氯胺酮组患者口干的报告频率高于曲马多组（p = 0.032）。
上腹部大手术后接受PCA-吗啡的患者，术后给予曲马多优于氯胺酮，因为其阿片类药物消耗量显著减少且疼痛评分更好。
