■改良根治术(MRM)与25-60%的患者可能发展为慢性疼痛综合征的严重急性术后疼痛有关。在接受MRM的患者中,锯齿前肌(SAM)阻滞已被证明是一种出色的镇痛选择。尽管许多佐剂已被用于延长镇痛,曲马多在SAM中的作用尚未被研究。我们假设,在进行选择性MRM手术的患者中,在罗哌卡因中添加曲马多用于SAM阻滞可能会减少术后吗啡的消耗。该研究的主要目的是比较接受有或没有曲马多的SAM阻滞的患者术后24小时内的累积吗啡消耗量。次要目的是观察与手术或药物相关的不良事件。记录的其他参数是无创血压(NIBP),脉搏率,呼吸频率,恶心或呕吐。
■计划接受MRM的患者通过区组随机化随机分为两组。研究组(T组)接受0.25%罗哌卡因(18ml)和曲马多100mg的SAM阻滞,而对照组(P组)接受0.25%罗哌卡因18ml和生理盐水2ml的SAM阻滞。评估患者的疼痛评分,镇痛需求,第一次镇痛请求的时间,血液动力学变量,以及30分钟时的任何副作用,1h,4h,8h,12h,术后24小时。
■T组术后24小时内的累积吗啡消耗量较少(3.06±1.53mgvs4.34±1.53mg;P0.001)。T组首次镇痛所需时间更长(10.44±5.04hvs6.11±2.73h;P<0.001)。在所有时间点,T组的疼痛评分均显着降低。
■曲马多,当将罗哌卡因用作SAM阻滞的佐剂时,可降低前24小时的术后疼痛评分,并延长首次吗啡需求的时间。
UNASSIGNED: Modified radical mastectomy (MRM) is associated with significant acute post-operative pain that may progress to chronic pain syndromes in 25-60% of patients. Serratus anterior muscle (SAM) block has proved to be an excellent analgesic option in patients undergoing MRM. Although many adjuvants have been utilized for the prolongation of analgesia, the role of tramadol in SAM has not been studied as yet. We hypothesize that the addition of tramadol to ropivacaine for SAM block may reduce morphine consumption in the post-operative period in patients undergoing elective MRM surgeries. The primary aim of the study was to compare cumulative post-operative morphine consumption over 24 h in patients receiving SAM block with or without tramadol. The secondary aims were to observe adverse events related to the procedure or medications. The other parameters recorded were non-invasive blood pressure (NIBP), pulse rate, respiratory rate, and nausea or vomiting.
UNASSIGNED: Patients scheduled to undergo MRM were randomly allocated by block randomization into two groups. The study group (Group T) received a SAM block with 0.25% ropivacaine (18 ml) with tramadol 100 mg while the control group (Group P) received a SAM block with 18 ml of 0.25% ropivacaine and 2 ml of saline. Patients were assessed for pain scores, analgesic requirement, time to first analgesic request, hemodynamic variables, and any side-effects at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h post-operatively.
UNASSIGNED: Cumulative morphine consumption over 24 h in the post-operative period was less in the group T (3.06 ± 1.53 mg vs 4.34 ± 1.53 mg; P 0.001). Time to the first analgesic requirement was more in group T (10.44 ± 5.04 h vs 6.11 ± 2.73 h; P < 0.001). Pain scores were significantly lower in the group T at all time points.
UNASSIGNED: Tramadol, when used as an adjuvant to ropivacaine for SAM block reduces post-operative pain scores in the first 24 h and prolongs the time of first morphine requirement.