Berti M, Albertin A, Casati A, Palmisano S, Municino G, da Gama Malcher M, De Ponti A
Dipartimento di Anestesia e Rianimazione, Università degli Studi, Milano.
Minerva Anestesiol. 2000 Jul-Aug;66(7-8):549-54.
This prospective, randomized study was conducted to evaluate the quality of postoperative pain relief when using dexketoprofen, ketoprofen, or paracetamol after outpatient knee arthroscopy.
Without premedication, 45 ASA physical status I-II patients undergoing elective outpatient knee arthroscopy with combined sciatic-femoral nerve block, were randomly allocated to receive either 25 mg oral dexketoprofen (n = 15), 50 mg oral ketoprofen (n = 15), or 500 mg oral paracetamol (n = 15) before block placement. After completion of surgery the same pain medication was given according to standard protocols, while 50 mg oral tramadol were allowed as rescue analgesic if required by the patient. After standard discharge criteria had been fulfilled, patients were discharged from the day-surgery unit, while a telephone follow-up was performed the day after surgery using standard questionnaires evaluating the quality of pain relief during the first 24 hours after surgery. Total consumption of rescue tramadol, maximum pain complained of after hospital discharge, as well as the visual analogue scale of pain measured at hospital discharge were assessed by an independent trained observer.
No differences in anthropometric variables, duration of surgical procedure, and fulfillment of discharge criteria were observed between the three groups. The degree of pain measured at rest at hospital discharge was similar in the three groups, while the VAS measured during motion was higher in patients receiving paracetamol (24 +/- 2.5 mm) than in those patients treated with dexketoprofen (13 +/- 6 mm) or ketoprofen (17 +/- 5 mm) (p = 0.016). Two patients (one in ketoprofen group and one in paracetamol group) required rescue tramadol after hospital discharge; however, no differences in maximum pain complained of after surgery or patient acceptance were observed between groups.
This prospective, randomized study demonstrated that in outpatients receiving arthroscopic knee surgery, the use of 75 mg/day dexketoprofen was as effective and safe as 150 mg/day racemate ketoprofen, with a better pain relief during motion compared to 2 g/day paracetamol when patients were discharged from the day-surgery unit.
本前瞻性随机研究旨在评估门诊膝关节镜检查术后使用右酮洛芬、酮洛芬或对乙酰氨基酚时的术后疼痛缓解质量。
45例ASA身体状况为I-II级、接受择期门诊膝关节镜检查并联合坐骨-股神经阻滞的患者，在未进行术前用药的情况下，于阻滞前随机分配接受25mg口服右酮洛芬（n = 15）、50mg口服酮洛芬（n = 15）或500mg口服对乙酰氨基酚（n = 15）。手术结束后，根据标准方案给予相同的止痛药物，若患者需要，可给予50mg口服曲马多作为解救镇痛药。在满足标准出院标准后，患者从日间手术单元出院，术后第1天使用标准问卷进行电话随访，评估术后24小时内的疼痛缓解质量。由一名独立的经过培训的观察者评估解救曲马多的总消耗量、出院后抱怨的最大疼痛程度以及出院时测量的疼痛视觉模拟评分。
三组之间在人体测量学变量、手术时间和出院标准的达成方面未观察到差异。出院时静息时测量的疼痛程度在三组中相似，而活动期间测量的视觉模拟评分在接受对乙酰氨基酚的患者中（24±2.5mm）高于接受右酮洛芬（13±6mm）或酮洛芬（17±5mm）治疗的患者（p = 0.016）。两名患者（酮洛芬组一名和对乙酰氨基酚组一名）出院后需要解救曲马多；然而，各组之间在术后抱怨的最大疼痛程度或患者接受度方面未观察到差异。
这项前瞻性随机研究表明，在接受膝关节镜手术的门诊患者中，每天使用75mg右酮洛芬与每天使用150mg消旋酮洛芬一样有效和安全，与每天使用2g对乙酰氨基酚相比，患者从日间手术单元出院时活动期间的疼痛缓解更好。
