1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA.
Acta Clin Croat. 2021 Jun;60(2):268-275. doi: 10.20471/acc.2021.60.02.13.
Tramadol is a commonly used analgesic in intensive care units (ICUs) for acute postoperative pain. Conversion of tramadol into active metabolites may be impaired in inflammatory states. Catechol-O-methyltransferase may influence pain. The aim of the study was to examine differences in the analgesic effect of tramadol between ICU patients with and without signs of systemic inflammation. Forty-three patients were admitted to ICU after a major abdominal surgery. The patients received a dose of 100 mg of tramadol intravenously every 6 hours during the first 24 hours after surgical procedure. Pain scores were measured by the Numeric Rating Scale before and 30 minutes after tramadol administration in awake patients. Systemic inflammation was considered when at least two of the following postoperative parameters were present in the first 24 hours of ICU admission: fever or hypothermia, tachycardia, pCO <4.3 kPa, white blood cells >12000/mm or <4000/mm, or preoperative value of C-reactive protein (CRP) >50 mg/L or/and procalcitonin (PCT) >0.5 mg/L. Catechol-O-methyltransferase was analyzed postoperatively. Fifteen (34.8%) patients met the criteria for systemic inflammation. Tramadol was proven to be an effective analgesic for the treatment of postoperative pain regardless of the presence of systemic inflammation (p<0.05). Lower perception of pain before tramadol application was observed in patients with systemic inflammation, but the difference was not significant. A negative correlation was observed between the preoperative values of CRP and PCT and the analgesic effect of tramadol assessed at the second measurement point (r=-0.358, p=0.03, and r=-0.364, p=0.02, respectively). Catechol-O-methyltransferase variants were not in correlation with pain and opioid consumption. Based on our findings, tramadol is effective in lowering pain scores after major abdominal surgery irrespective of the presence of systemic inflammation.
曲马多是重症监护病房（ICU）中用于治疗急性术后疼痛的常用镇痛药。在炎症状态下，曲马多可能会转化为活性代谢物。儿茶酚-O-甲基转移酶可能会影响疼痛。本研究旨在研究 ICU 中存在和不存在全身炎症迹象的患者使用曲马多后的镇痛效果差异。43 例患者在腹部大手术后被收入 ICU。在手术后的头 24 小时内，患者每 6 小时静脉注射 100 毫克曲马多。在清醒的患者中，在给予曲马多前和 30 分钟后，使用数字评分量表测量疼痛评分。如果 ICU 入院后前 24 小时内至少存在以下两个术后参数，则认为存在全身炎症：发热或低体温、心动过速、pCO <4.3 kPa、白细胞计数 >12000/mm 或 <4000/mm，或术前 C 反应蛋白（CRP）>50 mg/L 或/和降钙素原（PCT）>0.5 mg/L。术后分析儿茶酚-O-甲基转移酶。15 例（34.8%）患者符合全身炎症标准。无论是否存在全身炎症，曲马多均被证明是治疗术后疼痛的有效镇痛药（p<0.05）。在存在全身炎症的患者中，在给予曲马多之前，疼痛的感知程度较低，但差异无统计学意义。在第二次测量点，术前 CRP 和 PCT 值与曲马多的镇痛效果呈负相关（r=-0.358，p=0.03，和 r=-0.364，p=0.02）。儿茶酚-O-甲基转移酶变体与疼痛和阿片类药物消耗无关。根据我们的发现，无论是否存在全身炎症，曲马多在腹部大手术后均能有效降低疼痛评分。
