Varrassi G, Marinangeli F, Agrò F, Aloe L, De Cillis P, De Nicola A, Giunta F, Ischia S, Ballabio M, Stefanini S
Department of Anesthesiology and Pain Management, University of L'Aquila, Italy.
Anesth Analg. 1999 Mar;88(3):611-6. doi: 10.1097/00000539-199903000-00028.
We assessed the relative morphine consumption in a combined analgesic regimen (on-demand morphine plus the nonopioids propacetamol or ketorolac) after gynecologic surgery. Two hundred women randomly received two i.v. doses of propacetamol 2 g or ketorolac 30 mg in a double-blinded, double-dummy trial. Patients were monitored for 12 h, and the following efficacy variables were assessed: total dose of morphine, pain intensity, and global efficacy. Safety and tolerability were evaluated by the occurrence of adverse events, especially the presence and intensity of gastrointestinal symptoms. Hemostatic variables were measured 30 and 60 min after the first infusion; arterial blood pressure, heart and respiratory rates, sedation scores, and renal and hepatic function were also assessed. Total morphine requirements were not significantly different between the propacetamol (10.6 +/- 4.8 mg) and ketorolac (10.2 +/- 4.4 mg) groups. The evolution of pain intensity and the global efficacy also showed similar patterns in the two groups: 70.2% of patients in the propacetamol group rated the efficacy as "good/ excellent" compared with 68.2% in the ketorolac group. There were no clinically significant changes in vital signs or laboratory values and no observed differences between the two groups, although ketorolac slightly, but not significantly, prolonged the bleeding time. Epigastric pain was present in 9% and 15% of patients receiving propacetamol and ketorolac, respectively. There were two adverse events in the propacetamol group and four in the ketorolac group. Propacetamol demonstrates an efficacy similar to that of ketorolac and has an excellent tolerability after gynecologic surgery.
Propacetamol and ketorolac, combined with patient-controlled analgesia morphine, show similar analgesic efficacy after gynecologic surgery. Morphine consumption and pain scores were comparable in the two studied groups. Propacetamol is as effective as ketorolac and has an excellent tolerability after gynecologic surgery.
我们评估了妇科手术后联合镇痛方案（按需使用吗啡加非阿片类药物丙帕他莫或酮咯酸）中的相对吗啡消耗量。在一项双盲、双模拟试验中，200名女性被随机静脉注射2克丙帕他莫或30毫克酮咯酸，分两次给药。对患者进行12小时监测，并评估以下疗效变量：吗啡总剂量、疼痛强度和总体疗效。通过不良事件的发生情况，尤其是胃肠道症状的存在和强度来评估安全性和耐受性。在首次输注后30分钟和60分钟测量止血变量；还评估动脉血压、心率和呼吸频率、镇静评分以及肾功能和肝功能。丙帕他莫组（10.6±4.8毫克）和酮咯酸组（10.2±4.4毫克）的吗啡总需求量无显著差异。两组的疼痛强度变化和总体疗效也呈现相似模式：丙帕他莫组70.2%的患者将疗效评为“良好/优秀”，而酮咯酸组为68.2%。生命体征或实验室值无临床显著变化，两组之间未观察到差异，尽管酮咯酸轻微但不显著地延长了出血时间。接受丙帕他莫和酮咯酸的患者中，分别有9%和15%出现上腹部疼痛。丙帕他莫组有2例不良事件，酮咯酸组有4例。丙帕他莫显示出与酮咯酸相似的疗效，且在妇科手术后具有良好的耐受性。
丙帕他莫和酮咯酸与患者自控镇痛吗啡联合使用时，在妇科手术后显示出相似的镇痛效果。两个研究组的吗啡消耗量和疼痛评分相当。丙帕他莫与酮咯酸一样有效，且在妇科手术后具有良好的耐受性。
