术前口服曲马多在神经外科手术超前镇痛的应用

PRE-EMPTIVE ANALGESIA WITH ORAL TRAMADOL FOR CRANIOTOMY

目的观察颅脑手术病人术前口服不同剂量曲马多对术后镇痛的效果以及副作用的发生率,探讨曲马多用于神经外科手术超前镇痛的合理用量。方法采用随机、双盲、平行对比的研究方法,择期神经外科全麻颅脑手术患者175例,随机分为三组安慰剂组、曲马多100mg组、曲马多200mg组。各组药物分别于术前2h口服。所有病人术后采用相同剂量的曲马多PCA镇痛。于术后48h内定时观察VAS疼痛评分,记录镇痛药用量、副作用。结果术后VAS疼痛评分各组间无统计学差异,术后4h内安慰剂组疼痛例数高于超前镇痛组(P<0.05)。口服曲马多各剂量组术后恶心呕吐发生率以曲马多200mg组较高。结论口服曲马多用于神经外科手术有明确的超前镇痛作用,术前口服曲马多100mg术后镇痛效果好,术后恶心及呕吐发生率较低,是较适宜的术前口服剂量。

Objective: This study was aimed to evaluate the post-operative analgesic efficacy and safety of oral tramadol used before craniotomy. Methods: The double -blind, randomized and placebo-controlled design was used; 175 neurosurgical patients, ASA physical I-II, were randomly distributed into three groups to receive orally placebo, tramadol 100mg, or tramadol 200mg, respectively. The drug was delivered as a double-blind manner 2h before operation. Patient-controlled analgesia (PCA) was used for the postoperative analgesia. The observation parameters included VAS scores, PCA demanded and delivered times, side effects with in 48h after operation. Results: Patients' VAS scores had not significant differences among three groups within 48h after operation, but the incidence of complaining postoperative pain was significantly more in the placebo group than the pre-emptive group within 4h after operation(P<0.05). The incidences of post-operative nausea' vomiting and dizziness were slightly higher in 200mg tramadol group. Conclusion: Oral tramadol of 100mg provided better pre-emptive analgesia, with less anesthetic consumption and less side effects.