[罂粟摘要]曲马多与舒芬太尼对吸烟或不吸烟男性术后疼痛的影响：一项随机临床试验

曲马多与舒芬太尼对吸烟或不吸烟男性术后疼痛的影响：一项随机临床试验

贵州医科大学 麻醉与心脏电生理课题

翻译:  严旭    编辑:   严旭  审校:  曹莹

背景：吸烟行为改变了镇痛阈值，这挑战了吸烟患者的术后疼痛管理。

目的：我们旨在评估曲马多与舒芬太尼在接受部分肝切除术的吸烟或不吸烟患者缓解术后疼痛方面的镇痛效果。

研究设计：双盲随机对照试验。

设置：中国上海东部肝胆外科医院。

方法：这项研究中的所有患者都是男性。共有66名吸烟患者被随机分配接受曲马多或舒芬太尼（n=33人）。此外，共有66名不吸烟的患者被随机分配接受曲马多或舒芬太尼（n=33人）。主要结果是在前48小时内服用额外的止痛药来控制术后疼痛。次要结果包括术后疼痛水平、术后恶心和呕吐的频率、镇静评分和手术后48小时内发烧的频率。

结果：在服用额外的止痛药时，检测到“镇痛策略”和“吸烟史”之间存在显著的相互作用。在吸烟者中，接受曲马多的人对额外剂量止痛药的要求明显低于接受舒芬太尼的人；在不吸烟的人中没有观察到这种差异。在手术后48小时内吸烟的患者中，曲马多组和舒芬太尼组的术后疼痛水平没有显著差异。在吸烟者和不吸烟者中，曲马多组和舒芬太尼组之间与治疗相关的不良事件的发生率没有显著差异。

局限性：该研究只包括男性患者。此外，仅在手术后48小时内评估了吸烟患者中曲马多的高级镇痛效果和不良事件的发生率。

结论：我们的数据表明，曲马多在缓解吸烟患者的术后疼痛方面比舒芬太尼具有更好的镇痛作用。

原始文献来源  ：

Kai Wei 1, Yanzhi Bi 2, Huihong Xu 1,The Effect of Tramadol Versus Sufentanil on Controlling Postoperative Pain for Men Who Smoke and Do Not Smoke: A Randomized Clinical Trial.Pain Physician. 2022 Dec;25(9):E1367-E1377.

英文原文：

The Effect of Tramadol Versus Sufentanil on Controlling Postoperative Pain for Men Who Smoke and Do Not Smoke: A Randomized Clinical Trial

Abstract

Background: Smoking behavior alters the analgesic threshold, which challenges postoperative pain management for patients who smoke.

Objectives: We aimed to assess the analgesic efficacy of tramadol versus sufentanil in relieving postoperative pain for patients who do and do not smoke who underwent a partial hepatectomy.

Study design: Double-blinded randomized controlled trial.

Setting: Eastern Hepatobiliary Surgery Hospital, Shanghai, China.

Methods: All patients in this study were men. A total of 66 patients who smoke were randomly assigned to receive tramadol or sufentanil (n = 33 each). In addition, a total of 66 patients who do not smoke were randomly assigned to receive tramadol or sufentanil (n = 33 each). The primary outcome was the consumption of additional analgesics within the first 48 hours to control postoperative pain. Secondary outcomes included the postoperative pain level, the frequency of postoperative nausea and vomiting, the sedation score, and the frequency of fever within 48 hours postsurgery.

Results: A significant interaction between "analgesic strategy" and "smoking history" was detected on the consumption of additional analgesics. In those who smoke, the requests for additional doses of analgesics were significantly less in those receiving tramadol than those receiving sufentanil; such a difference was not observed in those who do not smoke. The postoperative pain level was not significantly different between the tramadol group and the sufentanil group within patients who smoke within 48 hours postsurgery. The incidence of treatment-related adverse events was not significantly different between the tramadol group and the sufentanil group within both those who do and do not smoke.

Limitations: Only men patients were included. Also, the superior analgesic effect and the incidence of adverse events of tramadol in patients who smoke were only assessed within the first 48 hours postsurgery.

Conclusions: Our data suggest that tramadol has a better analgesic effect than sufentanil in relieving postoperative pain in patients who smoke.