Kokki H, Tuovinen K, Hendolin H
Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland.
Anesth Analg. 1999 May;88(5):1036-41. doi: 10.1097/00000539-199905000-00012.
We compared the effect of IV ketoprofen and placebo as an adjuvant to epidural sufentanil analgesia after major surgery. We used a prospective, randomized, double-blinded, placebo-controlled, parallel-group study design in 54 children aged 1-15 yr who received a standardized anesthetic. Either IV ketoprofen or saline was administered in addition to an epidural sufentanil infusion, which was adjusted as required clinically. The study drug infusions were discontinued when pain scores were <3 on 0-10 scale for 6 h at a sufentanil infusion rate of 0.03 microg x kg(-1) x h(-1). Children in the ketoprofen group had a better analgesic effect, as shown by decreased need for sufentanil (mean [10th-90th percentiles] 8.3 [3.1-15.1] microg/kg vs 12.5 [6.2-18.9] microg/kg; P = 0.002) and earlier possibility to discontinuation of the epidural sufentanil (11 [46%] vs 3 [13%]; P = 0.014) before the end of the 72-h study period. In the ketoprofen group, median (range) pain scores were lower during activity at 24 h (2 [0-5] vs 5 [0-7]; P = 0.01) and at 72 h (0 [0-3] vs 2 [0-6]; P = 0.033), and fewer children had inadequate pain relief during activity at 24 h (0 vs 5; P = 0.037). Children who received ketoprofen required fewer infusion rate adjustments (12 [4-20] vs 17 [6-42]; P = 0.016). In the ketoprofen group, the incidence of desaturation (1 [4%] vs 6 [26%]; P = 0.035) and fever (3 [12%] vs 11 [48%]; P = 0.008) was less than that in the placebo group. We conclude that ketoprofen improved postoperative pain in children.
We compared the effect of the IV nonsteroidal antiinflammatory drug ketoprofen versus placebo as adjuvants to epidural opioid analgesia with sufentanil. The continuous IV nonsteroidal antiinflammatory drug improved pain after major surgery in children receiving an epidural opioid. Although ketoprofen reduced epidural sufentanil requirements, the incidence of opioid-related adverse effects was not changed.
我们比较了静脉注射酮洛芬和安慰剂作为大手术后硬膜外舒芬太尼镇痛辅助药物的效果。我们采用前瞻性、随机、双盲、安慰剂对照、平行组研究设计，对54名年龄在1至15岁接受标准化麻醉的儿童进行研究。除了根据临床需要调整硬膜外舒芬太尼输注外，还静脉注射酮洛芬或生理盐水。当疼痛评分在0至10分制中<3分持续6小时且舒芬太尼输注速率为0.03微克·千克⁻¹·小时⁻¹时，停止研究药物输注。酮洛芬组儿童的镇痛效果更好，表现为舒芬太尼需求量减少（均值[第10 - 90百分位数]8.3[3.1 - 15.1]微克/千克对12.5[6.2 - 18.9]微克/千克；P = 0.002），且在72小时研究期结束前更早停用硬膜外舒芬太尼的可能性更大（11例[46%]对3例[13%]；P = 0.014）。在酮洛芬组，24小时活动时（2[0 - 5]对5[0 - 7]；P = 0.01）和72小时活动时（0[0 - 3]对2[0 - 6]；P = 0.033）的中位（范围）疼痛评分更低，且24小时活动时疼痛缓解不足的儿童更少（0例对5例；P = 0.037）。接受酮洛芬的儿童所需的输注速率调整更少（12[4 - 20]对17[6 - 42]；P = 0.016）。在酮洛芬组，低氧血症发生率（1例[4%]对6例[26%]；P = 0.035）和发热发生率（3例[12%]对11例[48%]；P = 0.008）低于安慰剂组。我们得出结论，酮洛芬可改善儿童术后疼痛。
我们比较了静脉注射非甾体抗炎药酮洛芬与安慰剂作为硬膜外阿片类药物舒芬太尼镇痛辅助药物的效果。持续静脉注射非甾体抗炎药可改善接受硬膜外阿片类药物的儿童大手术后的疼痛。虽然酮洛芬减少了硬膜外舒芬太尼的需求量，但与阿片类药物相关的不良反应发生率并未改变。
