Hopkins D, Shipton E A, Potgieter D, Van derMerwe C A, Boon J, De Wet C, Murphy J
Department of Anaesthesiology, Hillbrow Hospital, University of The Witwatersrand, Johannesburg, South Africa.
Can J Anaesth. 1998 May;45(5 Pt 1):435-42. doi: 10.1007/BF03012579.
To compare subcutaneous PCA tramadol with subcutaneous PCA morphine for postoperative pain relief after major orthopaedic surgery and for the incidence of side-effects.
In a double-blind randomised controlled study 40 patients (20 in each group) self-administered either tramadol or morphine for 72 hr after surgery via s.c. PCA. The following variables were recorded at various time intervals: (i) pain score by means of a visual analogue scale, (ii) drug consumption and total PCA demands, (iii) vital signs (blood pressure and heart rate), (iv) oxygen saturation and respiratory rate, and (v) side-effects (sedation, nausea/vomiting, pruritus, urinary retention and constipation).
Both drugs provided effective analgesia. The mean consumption in the first 24 hr was 792 +/- 90 mg tramadol and 42 +/- 4 mg morphine. Thereafter, consumption of both drugs declined markedly. Moderate haemodynamic changes were observed in both the tramadol and morphine groups (with a maximum 20% decrease in mean blood pressure and a maximum 17% increase in heart rate) during the 72 hr period. Both tramadol and morphine were associated with a clinically and statistically significant (P < 0.001) decrease in oxygen saturation, but without changes in respiratory rates. Desaturation was less marked with tramadol. Tramadol appeared to cause more nausea and vomiting than morphine. Sedation was mild and only seen during the first few hours after surgery in both groups.
Tramadol is an effective analgesic agent for the relief of acute postoperative pain when administered by PCA via the subcutaneous route. Under these conditions tramadol behaves much like morphine with a similar side-effect profile.
比较皮下自控镇痛（PCA）曲马多与皮下PCA吗啡用于骨科大手术后疼痛缓解及副作用发生率的情况。
在一项双盲随机对照研究中，40例患者（每组20例）术后通过皮下PCA自行给药曲马多或吗啡72小时。在不同时间间隔记录以下变量：（i）采用视觉模拟量表的疼痛评分，（ii）药物消耗量和PCA总需求量，（iii）生命体征（血压和心率），（iv）血氧饱和度和呼吸频率，以及（v）副作用（镇静、恶心/呕吐、瘙痒、尿潴留和便秘）。
两种药物均提供了有效的镇痛效果。前24小时曲马多的平均消耗量为792±90毫克，吗啡为42±4毫克。此后，两种药物的消耗量均显著下降。在72小时期间，曲马多组和吗啡组均观察到中度血流动力学变化（平均血压最大下降20%，心率最大增加17%）。曲马多和吗啡均与血氧饱和度在临床和统计学上有显著下降（P<0.001），但呼吸频率无变化。曲马多引起的血氧饱和度下降不太明显。曲马多似乎比吗啡引起更多的恶心和呕吐。两组镇静均较轻，仅在术后最初几小时出现。
曲马多通过皮下途径PCA给药时是缓解术后急性疼痛的有效镇痛药。在这些情况下，曲马多的表现与吗啡非常相似，副作用情况也相似。
