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Estimation of the minimum effective dose of tramadol for postoperative analgesia in infants using the

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《医学前沿（英文）》 2012年第6卷第3期页码 288-295 doi: 10.1007/s11684-012-0208-4

摘要：

Tramadol is a potent analgesic. However, the analgesia efficacy of tramadol, particularly its minimum effective dose (MED), is not clear. The aim of this study is to find MED of tramadol for postoperative analgesia in infants. The continual reassessment method (CRM) was performed to find MED. Infants undergoing surgeries were included in the 3 phases of this series. In each phase, 24 participants were allocated a different tramadol dose. Pain intensity was measured by face, legs, activity, cry, consolability (FLACC) measurement at 3-hour intervals. Tramadol was considered ineffective if the FLACC score was higher than 4 in 10 at anytime. In phase 1, seven dose levels were used within the range 0.1–0.4 mg?kg^-1·h^-1. Phase 1 was insufficient to identify the MED, and we increased the dose to 0.4–0.8 mg?kg^-1·h^-1 in phase 2. Phase 2 was insufficient to identify the MED. In phase 3, local anesthetic wound infiltration was introduced, and the tramadol dose levels tested were the same as in phase 1. The successful analgesia probability of tramadol 0.4 mg?kg^-1?h^-1 was 82.1% (95% CI, 0.742–0.925) in phase 1. In phase 2, it was 84.7% (95% CI, 0.789–0.991) with the dose 0.8 mg?kg^-1?h^-1. Phase 1 and phase 2 were insufficient to identify the MED. In phase 3, the successful analgesia probability for dose 0.35 mg?kg^-1?h^-1was 96.7% (95% CI, 0.853–0.997).We have demonstrated that tramadol provides insufficient analgesia for surgeries considered to cause moderate-to-severe postoperative pain in infants if used as the sole analgesic, and that local anesthetic wound infiltration enhances the efficacy of tramadol.

关键词： tramadol minimum effective dose postoperative analgesia infants continual reassessment method

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Distinct roles of ASIC3 and TRPV1 receptors in electroacupuncture-induced segmental and systemic analgesia

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《医学前沿（英文）》 2016年第10卷第4期页码 465-472 doi: 10.1007/s11684-016-0482-7

摘要：

Previous studies have demonstrated the effects of different afferent fibers on electroacupuncture (EA)-induced analgesia. However, contributions of functional receptors expressed on afferent fibers to the EA analgesia remain unclear. This study investigates the roles of acid-sensing ion channel 3 (ASIC3) and transient receptor potential vanilloid 1 (TRPV1) receptors in EA-induced segmental and systemic analgesia. Effects of EA at acupoint ST36 with different intensities on the C-fiber reflex and mechanical and thermal pain thresholds were measured among the ASIC3⁻^/⁻, TRPV1⁻^/⁻, and C57BL/6 mice. Compared with C57BL/6 mice, the ipsilateral inhibition of EA with 0.8 C-fiber threshold (0.8Tc) intensity on C-fiber reflex was markedly reduced in ASIC3⁻^/⁻ mice, whereas the bilateral inhibition of 1.0 and 2.0Tc EA was significantly decreased in TRPV1⁻^/⁻ mice. The segmental increase in pain thresholds induced by 0.3 mA EA was significantly reduced in ASIC3⁻^/⁻ mice, whereas the systemic enhancement of 1.0 mA EA was markedly decreased in TRPV1⁻^/⁻ mice. Thus, segmental analgesia of EA with lower intensity is partially mediated by ASIC3 receptor on Aβ-fiber, whereas systemic analgesia induced by EA with higher intensity is more likely induced by TRPV1 receptor on Ad- and C-fibers.