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首页> 外文期刊>International Journal of Research in Medical Sciences >A prospective randomized study to compare tramadol and morphine for postoperative analgesia in spine surgeries using intravenous patient controlled analgesia
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A prospective randomized study to compare tramadol and morphine for postoperative analgesia in spine surgeries using intravenous patient controlled analgesia

机译：一项前瞻性随机研究，比较曲马多和吗啡对脊柱外科手术中使用静脉内自控镇痛的镇痛效果

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Background: Spine surgeries particulary spine fusion surgeries provide a unique challenge with respect to postoperative analgesia as the choices to provide analgesia are limited. Uses of NSAIDS and neuroaxial anaesthesia for post-operative analgesia in spine surgeries have been controversial. Patient controlled analgesia with opioids is commonly used and morphine remains the gold standard. The aim of this study was to compare tramadol with morphine for postoperative analgesia in spine surgeries using iv patient controlled analgesia. Methods: A total of 80 adult patients of ASA grade I and 2 undergoing spine surgeries and divided into two groups i.e. morphine group M and tramadol group T with 40 patients in each group were included in the study. pain assessment was done by NRS (numeric rating scale) upto 48 hours postoperatively other parameters like nausea/vomiting and sedation were also noted. Both groups received boluses initially to control pain. Group M patients received 1mg i.v demand dose of morphine with lock out time of 10-15 minutes and in Group T patients PCA device was set to deliver 20mg i.v demand dose of tramadol with lock out time of 10-15 minutes. A bolus of 25mcg fentanyl was given as rescue analgesia in both groups by the nurse if required. No background infusion or four-hour maximal limit was set on PCA pumps. Results: Pain scores remained on lower side in both the groups, though slightly better with morphine and the difference was statistically significant at 4 hours, 12 hours and 24 hours. The total NRS mean value (0-48 hours) of morphine and tramadol is 3.270 and 3.629 with p value of 0.015 which is statistically significant. 7 patients in morphine group received rescue analgesia while it was received by 15 patients in tramadol group with p value of 0.78 which is statistically insignificant. Nausea and Vomiting was encountered more frequently in the tramadol group. Mean mobilization time in patients of tramadol group was 21.72 hours and that of morphine group was 17.10 hours with p value of 0.00 which is highly significant. Conclusions: Morphine and tramadol when used in PCA mode provide adequate pain relief post operatively after spine surgeries with morphine showing slightly better analgesia profile and significantly less nausea and vomiting than tramadol.
机译：背景：脊柱手术特别是脊柱融合手术在术后镇痛方面提供了独特的挑战，因为提供镇痛的选择有限。在脊柱外科手术中使用NSAIDS和神经轴向麻醉进行术后镇痛一直存在争议。病人通常使用阿片类药物进行自控镇痛，吗啡仍然是金标准。这项研究的目的是比较曲马多与吗啡在静脉内自控镇痛对脊柱手术术后镇痛的作用。方法：本研究共纳入80例ASAⅠ级和2例ASA的成年成人患者，分为两组，即吗啡M组和曲马多T组，每组40例。术后48小时通过NRS（数字评分量表）进行疼痛评估，还注意到其他参数，如恶心/呕吐和镇静。两组最初都接受了大剂量药物来控制疼痛。 M组患者接受1mg静脉内需求剂量的吗啡，锁定时间为10-15分钟;在T组患者中，将PCA装置设置为递送20mg iv需求量的曲马多，锁定时间为10-15分钟。两组护士均按需给予25mcg芬太尼大丸作为抢救性镇痛药。在PCA泵上没有设置背景输液或设置了四个小时的最大限制。结果：两组患者的疼痛评分均较低，尽管吗啡组稍好，并且在4小时，12小时和24小时时差异有统计学意义。吗啡和曲马多的总NRS平均值（0-48小时）为3.270和3.629，p值为0.015，具有统计学意义。吗啡组中有7例接受了镇痛，而曲马多组中有15例接受了镇痛，p值为0.78，在统计学上无统计学意义。在曲马多组中，恶心和呕吐的发生率更高。曲马多组患者的平均动员时间为21.72小时，吗啡组患者的平均动员时间为17.10小时，p值为0.00，具有非常显着的意义。结论：吗啡和曲马多用于PCA模式时可在脊柱手术后提供足够的疼痛缓解，吗啡显示出比曲马多稍微更好的镇痛效果，并且明显减少了恶心和呕吐。

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