Norman P H, Daley M D, Lindsey R W
Department of Anesthesiology, University of Texas M.D. Anderson Cancer Center, Houston, USA.
Anesthesiology. 2001 Apr;94(4):599-603. doi: 10.1097/00000542-200104000-00012.
Preemptive analgesia has been difficult to show in human experiments. If ketorolac has preemptive effects, then there may be an advantage to administering it at the beginning of surgery despite the potential for increased blood loss.
The authors performed a randomized, double-blind, controlled trial of 48 patients scheduled for ankle fracture surgery in a county trauma hospital. Anesthesia management was standardized and included adequate opioid analgesia (5 microg/kg fentanyl and 0.1 mg/kg morphine). Intravenous 30 mg ketorolac was administered to 23 patients before tourniquet inflation and to 25 patients after tourniquet inflation. Visual analog scale pain scores, morphine patient-controlled analgesia consumption, nausea-vomiting, and postoperative bleeding were measured.
The 23 patients given ketorolac before tourniquet inflation had no increase in pain postoperatively compared with their preoperative baseline (P = 0.280). The 25 patients who received ketorolac minutes later after tourniquet inflation had significant increases in their postoperative pain compared with their preoperative baseline (P = 0.00116). This effect was short-lived, and by 6 h the pain score in this group was not significantly more than it was preoperatively. Intergroup comparison showed a lower visual analog scale score at 2 (P = 0.0203) and 4 h (P = 0.00549) in the preemptive group and lower nausea scores at hour 6 (P = 0.00704). There was no difference in patient-controlled analgesia consumption between groups.
Intravenous 30 mg ketorolac appears to have preemptive analgesic effects in patients undergoing ankle fracture repair. Ketorolac administered before tourniquet inflation prevents postoperative pain being perceived as more intense than preoperative pain.
预防性镇痛在人体实验中一直难以得到证实。如果酮咯酸具有预防性作用，那么尽管可能会增加失血风险，但在手术开始时给予该药可能具有优势。
作者在一家县创伤医院对48例计划行踝关节骨折手术的患者进行了一项随机、双盲、对照试验。麻醉管理标准化，包括给予足量的阿片类镇痛药（5微克/千克芬太尼和0.1毫克/千克吗啡）。23例患者在止血带充气前静脉注射30毫克酮咯酸，25例患者在止血带充气后注射。测量视觉模拟评分法疼痛评分、吗啡患者自控镇痛用量、恶心呕吐情况及术后出血情况。
在止血带充气前给予酮咯酸的23例患者术后疼痛与术前基线相比无增加（P = 0.280）。在止血带充气后数分钟给予酮咯酸的25例患者术后疼痛与术前基线相比显著增加（P = 0.00116）。这种效应是短暂的，到6小时时该组疼痛评分与术前相比并无显著增加。组间比较显示，预防性用药组在2小时（P = 0.0203）和4小时（P = 0.00549）时视觉模拟评分较低，在6小时时恶心评分较低（P = 0.00704）。两组间患者自控镇痛用量无差异。
静脉注射30毫克酮咯酸似乎对接受踝关节骨折修复术的患者具有预防性镇痛作用。在止血带充气前给予酮咯酸可防止术后疼痛比术前疼痛更剧烈。
