Pavy T J, Paech M J, Evans S F
Department of Anaesthesia and Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Subiaco 6008, Western Australia, Australia.
Anesth Analg. 2001 Apr;92(4):1010-4. doi: 10.1097/00000539-200104000-00038.
Nonsteroidal antiinflammatory drugs, including ketorolac, are widely used for postoperative analgesia. This randomized, double-blinded trial compared IV ketorolac or saline combined with meperidine patient-controlled epidural analgesia (PCEA) after cesarean delivery. Fifty healthy parturients scheduled for elective cesarean delivery under combined spinal-epidural anesthesia received PCEA plus either IV ketorolac (Group K) or saline (Group C) for 24 h. The ketorolac dose was modified, after six patients had been studied, based on new product information recommending a maximum of 120 mg ketorolac over 24 h. Group K (n = 24) and Group C (n = 20) were demographically similar. During the first 24 h, Group K used significantly less meperidine (P < 0.05). Postoperative pain at rest and with movement, and patient satisfaction, did not differ significantly between groups, except that worst pain at 12 h was less in Group K (P < 0.005). The two groups were similar with respect to patient recovery and side effects. IV ketorolac, as an adjunct to PCEA after cesarean delivery, produced a meperidine dose-sparing effect of approximately 30%, but did not significantly improve pain relief, reduce opioid-related side effects, or change patient outcome.
包括酮咯酸在内的非甾体抗炎药被广泛用于术后镇痛。本随机双盲试验比较了剖宫产术后静脉注射酮咯酸或生理盐水联合哌替啶患者自控硬膜外镇痛（PCEA）的效果。50例计划在腰麻-硬膜外联合麻醉下择期行剖宫产的健康产妇接受PCEA，并在24小时内静脉注射酮咯酸（K组）或生理盐水（C组）。在研究了6例患者后，根据新产品信息将酮咯酸剂量调整为24小时内最大剂量120mg。K组（n = 24）和C组（n = 20）在人口统计学上相似。在最初的24小时内，K组使用的哌替啶显著较少（P < 0.05）。术后静息和活动时的疼痛以及患者满意度在两组之间没有显著差异，只是K组12小时时的最严重疼痛较轻（P < 0.005）。两组在患者恢复和副作用方面相似。剖宫产术后静脉注射酮咯酸作为PCEA的辅助用药，可产生约30%的哌替啶节省效应，但并未显著改善疼痛缓解、减少阿片类药物相关副作用或改变患者预后。
