Lauretti G R, Mattos A L, Lima I C
Department of Surgical Orthopedics and Traumatology, Hospital das Clinicas Faculty of Medicina Ribeirão Preto-USP, São Paulo, Brazil.
Reg Anesth. 1997 May-Jun;22(3):243-8. doi: 10.1016/s1098-7339(06)80009-x.
This study was conducted to evaluate the analgesic efficacy of tramadol, an analgesic with both opioid and nonopioid actions (norepinephrine and serotonin pathways), with beta-cyclodextrin piroxicam, a nonsteroidal antiinflammatory drug, in the perioperative setting.
The study population consisted of 48 patients scheduled for minor abdominal procedures, who were assigned to one of four groups of 12 patients each. The premedication was either a placebo tablet or a 192.1-mg beta-cyclodextrin piroxicam tablet, administered orally 30-40 minutes before anesthesia induction. After intravenous administration of tramadol 1.5 mg/kg, anesthesia was induced with an intravenous loading dose of propofol. Anesthesia was maintained an intravenous infusion of propofol at 6-12 mg/kg/h plus either saline or tramadol at 1.2 mg/kg/h, atracurium, and a 2:1 nitrous oxide-oxygen mixture. The control group received a placebo tablet and an infusion of saline with propofol for anesthesia maintenance; the tramadol group received a placebo tablet and a continuous tramadol-propofol infusion; the beta-cyclodextrin piroxicam (BCP) group received a BCP tablet and a continuous saline-propofol infusion; and the beta-cyclodextrin piroxicam-tramadol (BCPT) group received beta-cyclodextrin piroxicam and a continuous tramadol-propofol infusion.
The relative propofol consumption by the four groups was control = BCP (P > .05) >tramadol (P < .001) > B-CPT (P < .0002). The time for analgesic rescue decreased in the order BCPT > BCP (P < .0002) = tramadol > control (P < .001). The degree of sedation and the visual analog scores 10-cm scale at the time patients requested rescue analgesics were similar among the groups (P > .05).
The combination of tramadol and beta-cyclodextrin piroxicam provided better perioperative analgesia than tramadol alone.
本研究旨在评估曲马多（一种兼具阿片类和非阿片类作用途径，即去甲肾上腺素和5-羟色胺途径的镇痛药）与β-环糊精吡罗昔康（一种非甾体抗炎药）在围手术期的镇痛效果。
研究对象为48例计划接受小型腹部手术的患者，他们被随机分为四组，每组12例。术前用药为安慰剂片或192.1毫克β-环糊精吡罗昔康片，于麻醉诱导前30-40分钟口服。静脉注射1.5毫克/千克曲马多后，以丙泊酚静脉负荷剂量诱导麻醉。麻醉维持采用静脉输注丙泊酚6-12毫克/千克/小时，加生理盐水或1.2毫克/千克/小时曲马多、阿曲库铵以及2:1氧化亚氮-氧气混合气体。对照组接受安慰剂片和生理盐水与丙泊酚混合液用于麻醉维持；曲马多组接受安慰剂片和持续曲马多-丙泊酚输注；β-环糊精吡罗昔康（BCP）组接受BCP片和持续生理盐水-丙泊酚输注；β-环糊精吡罗昔康-曲马多（BCPT）组接受β-环糊精吡罗昔康和持续曲马多-丙泊酚输注。
四组丙泊酚相对用量为对照组=BCP组（P>.05）>曲马多组（P<.001）>BCPT组（P<.0002）。镇痛补救时间按BCPT组>BCP组（P<.0002）=曲马多组>对照组（P<.001）的顺序递减。各组患者请求补救镇痛药时的镇静程度和视觉模拟评分（10厘米量表）相似（P>.05）。
曲马多与β-环糊精吡罗昔康联合使用比单独使用曲马多能提供更好的围手术期镇痛效果。
