A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients
A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients
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DOI：
10.1097/00000539-200111000-00052
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发表时间：
2001-11-01
影响因子：
5.7
通讯作者：
Chu, KS
中科院分区：
文献类型：
--
作者：
Tsai, YC;Chu, KS
曲马多可有效治疗产妇硬膜外麻醉期间的颤抖。除了与阿片受体的低亲和力外，曲马多还对中枢单胺能通路发挥调节作用。在这方面，曲马多和阿米替林等抗抑郁药的作用机制有相似之处。哌替啶通常被推荐用于治疗麻醉后颤抖。这项前瞻性、双盲、随机临床研究的目的是比较曲马多、哌替啶和阿米替林治疗硬膜外麻醉后寒战的抗寒效果和伴随的副作用。 45 名在硬膜外麻醉下剖宫产期间出现寒颤并要求抗寒颤治疗的产妇被随机分配到三组之一进行静脉注射治疗：T 组（n = 15）接受曲马多 0.5 mg/kg，M 组（n = 15）接受哌替啶 0.5 mg/kg，A 组（n = 15）接受阿米替林 15 或 20 mg。 T 组和 M 组的缓解率（治疗后 15 分钟内颤抖停止）分别为 87% 和 93%，而 A 组为 13%（P < 0.01）。从治疗到颤抖停止的时间，T 组为 5.1 +/- 3.6 分钟（平均 SD），M 组为 4.2 +/- 2.3 分钟。与 T 组（7%）和 A 组（0%）相比，M 组的嗜睡发生率（33%）明显更高（P < 0.01）。然而，新生儿的瘙痒、恶心、呕吐或阿普加评分没有显着差异。我们得出的结论是，与所用剂量的阿米替林相比，曲马多和哌替啶在治疗硬膜外麻醉后颤抖方面显示出明显更快的反应率；与哌替啶相比，曲马多的嗜睡发生率降低。
Tramadol is effective for treating shivering during epidural anesthesia in parturients. In addition to its low affinity to opioid receptors, tramadol exerts a modulatory effect on central monoaminergic pathways. In this respect, there are parallels between the mechanisms of the action of tramadol and antidepressants such as amitriptyline. Meperidine is often recommended for the treatment of postanesthetic shivering. This prospective, double-blinded, and randomized clinical study was performed to compare the antishivering effects and accompanying side effects among tramadol, meperidine, and amitriptyline for the treatment of postepidural anesthetic shivering. Forty-five parturients who shivered during cesarean delivery under epidural anesthesia and requested antishivering treatment were randomly allocated to one of three groups for IV treatment: Group T (n = 15) received tramadol 0.5 mg/kg, Group M (n = 15) received meperidine 0.5 mg/kg, and Group A (n = 15) received amitriptyline 15 or 20 mg. The response rate (shivering ceased after treatment in 15 min) was 87% and 93% for Groups T and M, respectively, compared with 13% in Group A (P < 0.01). The time that elapsed from treatment to the time shivering ceased was 5.1 +/- 3.6 min (mean SD) for Group T and 4.2 +/- 2.3 min for Group M. There was a significantly more frequent incidence (33%) of somnolence in Group M when compared with Groups T (7%) and A (0%) (P < 0.01). However, no significant differences were shown for pruritus, nausea, vomiting, or Apgar scores of newborns. We concluded that both tramadol and meperidine show a significantly faster response rate in the treatment of postepidural anesthetic shivering when compared with amitriptyline in the dosage used; tramadol had a decreased incidence of somnolence when compared with meperidine.