Staritz M, Poralla T, Manns M, Meyer Zum Büschenfelde K H
Gut. 1986 May;27(5):567-9. doi: 10.1136/gut.27.5.567.
Modern narcotic analgesic drugs, such as tramadol, pentazocine, and buprenorphine share similarities of molecular structure with morphine which is widely believed to cause spasm of the bile duct sphincter and so impede bile flow. This study assessed the effects of intravenously administered analgesics on bile duct sphincter motor activity measured by ERCP manometry. Ten minutes after pentazocine injection the duration of contractions and baseline pressure of the bile duct sphincter rose from 6.2 +/- 0.2 to 8.2 +/- 0.27 s and from 5.1 +/- 0.6 to 8.8 +/- 0.4 mmHg respectively. Tramadol, buprenorphine and saline showed no such effect. These data indicated that the effects of such drugs on bile duct sphincter function can be safely assessed by ERCP manometry and that pentazocine adversely affects the bile duct sphincter, whilst tramadol and buprenorphine do not. We consider therefore that pentazocine is not the premedication of first choice for endoscopic procedures involving the sphincter of Oddi and should also be avoided in patients with pancreatic and biliary disorders.
现代麻醉性镇痛药，如曲马多、喷他佐辛和丁丙诺啡，其分子结构与吗啡相似，而吗啡被广泛认为会导致胆管括约肌痉挛，从而阻碍胆汁流动。本研究通过内镜逆行胰胆管造影（ERCP）测压法评估了静脉注射镇痛药对胆管括约肌运动活性的影响。注射喷他佐辛10分钟后，胆管括约肌收缩持续时间和基础压力分别从6.2±0.2秒升至8.2±0.27秒，从5.1±0.6毫米汞柱升至8.8±0.4毫米汞柱。曲马多、丁丙诺啡和生理盐水未显示出此类效果。这些数据表明，此类药物对胆管括约肌功能的影响可通过ERCP测压法安全评估，喷他佐辛会对胆管括约肌产生不利影响，而曲马多和丁丙诺啡则不会。因此，我们认为喷他佐辛不是涉及Oddi括约肌的内镜手术的首选术前用药，患有胰腺和胆道疾病的患者也应避免使用。
