Tarradell R, Pol O, Farré M, Barrera E, Puig M M
Department of Anesthesiology, Hospital Universitario del Mar, IMIM, Barcelona, Spain.
Methods Find Exp Clin Pharmacol. 1996 Apr;18(3):211-8.
The respiratory and analgesic effects of i.v. meperidine, tramadol and their correlation with plasma concentrations of meperidine, tramadol and O-demethyltramadol were determined. Forty-eight patients after total hip or knee replacement were randomly distributed into 3 groups (n = 16 each). At the time of analgesia request, they received in a double-blind manner, i.v. single doses of 100 mg meperidine, 100 mg tramadol, or saline. Thirty minutes after treatment, patients who requested additional analgesia were rescued with 75 mg diclofenac and morphine as required. Patients were evaluated at the time of analgesia request and at set intervals during 4 h. Meperidine induced sedation (p < 0.05), respiratory depression (tidal volume, p < 0.047; respiratory rate, p < 0.004; % O2 Sat, p < 0.036), and hypercapnia (PaCO2, p < 0.002). Incidence of nausea and vomiting was higher with tramadol (p < 0.02). For the first 30 min, meperidine produced lower pain intensity scores than tramadol or saline (p < 0.05). At this time, 14/16 patients on saline, 8/16 on meperidine and 11/16 on tramadol were rescued. Onset for meperidine analgesia was 10 min and > 30 min for tramadol. Both opioids produced similar degree of analgesia in patients who were not rescued. A negative correlation (r = -0.99) between analgesia and tramadol concentrations and a poor positive correlation (r = +0.54) with O-demethyltramadol (a metabolite of tramadol) was observed. Pain intensity differences correlated negatively with meperidine plasma concentrations during the first 30 min (r = -0.97) and positively thereafter (r = +0.92). In the present study, meperidine and tramadol produced comparable analgesia, with a different time course profile, but meperidine induced sedation and respiratory depression while tramadol did not.
测定了静脉注射哌替啶、曲马多的呼吸和镇痛作用及其与哌替啶、曲马多和O-去甲基曲马多血浆浓度的相关性。48例全髋关节或膝关节置换术后患者被随机分为3组（每组n = 16）。在要求镇痛时，他们以双盲方式静脉注射单剂量100mg哌替啶、100mg曲马多或生理盐水。治疗30分钟后，要求追加镇痛的患者按需给予75mg双氯芬酸和吗啡进行解救。在要求镇痛时以及4小时内的设定时间间隔对患者进行评估。哌替啶可引起镇静（p < 0.05）、呼吸抑制（潮气量，p < 0.047；呼吸频率，p < 0.004；血氧饱和度百分比，p < 0.036）和高碳酸血症（动脉血二氧化碳分压，p < 0.002）。曲马多引起恶心和呕吐的发生率更高（p < 0.02）。在最初30分钟内，哌替啶产生的疼痛强度评分低于曲马多或生理盐水（p < 0.05）。此时，14/16接受生理盐水治疗的患者、8/16接受哌替啶治疗的患者和11/16接受曲马多治疗的患者接受了解救。哌替啶镇痛起效时间为10分钟，曲马多则> 30分钟。在未接受解救的患者中，两种阿片类药物产生的镇痛程度相似。观察到镇痛与曲马多浓度之间呈负相关（r = -0.99），与O-去甲基曲马多（曲马多的一种代谢产物）呈弱正相关（r = +0.54）。在最初30分钟内，疼痛强度差异与哌替啶血浆浓度呈负相关（r = -0.97），此后呈正相关（r = +0.92）。在本研究中，哌替啶和曲马多产生了相当的镇痛效果，但时间过程不同，且哌替啶可引起镇静和呼吸抑制，而曲马多则不会。
