Sharma S, Chang D W, Koutz C, Evans G R, Robb G L, Langstein H N, Kroll S S
Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Plast Reconstr Surg. 2001 Feb;107(2):352-5. doi: 10.1097/00006534-200102000-00009.
Ketorolac is frequently used as an adjunct for postoperative pain relief, especially by anesthesiologists during the immediate postoperative period. It can be used alone as an analgesic but is more often used to potentiate the actions of narcotics such as morphine or meperidine in an attempt to reduce the total dose and side effects of those drugs. The manufacturer of ketorolac cautions against its use in patients who have a high risk of postoperative bleeding, for fear of increasing the risk of hematoma, but the risk in transverse rectus abdominis musculocutaneous (TRAM) flap patients has never been reported. In a study of 215 patients who had undergone TRAM flap breast reconstruction, it was determined that patients who received intravenous ketorolac (n = 65) as an adjunct to their treatment with morphine administered by use of a patient-controlled analgesia device required less morphine (mean cumulative dose, 1.39 mg/kg) than did patients who did not receive ketorolac (n = 150; mean cumulative dose, 1.75 mg/kg; p = 0.02). There was no increase in the incidence of hematoma in patients who were treated with ketorolac. The data presented in this study suggest that the use of intravenous ketorolac does reduce the need for narcotics administration in patients undergoing TRAM flap breast reconstruction, without significantly increasing the risk of hematoma.
酮咯酸经常被用作术后疼痛缓解的辅助药物，尤其是在术后即刻由麻醉医生使用。它可以单独用作镇痛药，但更常用于增强吗啡或哌替啶等麻醉药的作用，以试图减少这些药物的总剂量和副作用。酮咯酸的制造商警告不要在有术后出血高风险的患者中使用，因为担心增加血肿风险，但在横行腹直肌肌皮瓣（TRAM）患者中的风险从未有过报道。在一项对215例行TRAM瓣乳房重建术患者的研究中，确定接受静脉注射酮咯酸（n = 65）作为使用患者自控镇痛装置给予吗啡治疗辅助的患者，比未接受酮咯酸的患者（n = 150；平均累积剂量，1.75 mg/kg；p = 0.02）需要更少的吗啡（平均累积剂量，1.39 mg/kg）。接受酮咯酸治疗的患者血肿发生率没有增加。本研究中呈现的数据表明，静脉注射酮咯酸确实可减少接受TRAM瓣乳房重建术患者的麻醉药使用需求，而不会显著增加血肿风险。
