Watcha M F, Ramirez-Ruiz M, White P F, Jones M B, Lagueruela R G, Terkonda R P
Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110.
Can J Anaesth. 1992 Sep;39(7):649-54. doi: 10.1007/BF03008224.
Prophylactic administration of analgesics before surgery can decrease the intraoperative anaesthetic requirement and decrease pain during the early postoperative period. In a double-blind, placebo-controlled study involving 90 healthy ASA physical status I or II children undergoing bilateral myringotomy, we compared the postoperative analgesic effects of oral acetaminophen and ketorolac, when administered 30 min before induction of anaesthesia. Patients were randomized to receive saline (0.1 ml.kg-1), acetaminophen (10 mg.kg-1) or ketorolac (1 mg.kg-1) diluted in cherry syrup to a total volume of 5 ml. Anaesthesia was induced and maintained with halothane and nitrous oxide via a face mask. Postoperative pain was assessed by a blinded observer using an objective pain scale. The three study groups were similar with respect to demographic data, duration of anaesthesia and surgery, induction behaviour, oxygen saturation, incidence of postoperative emesis and, recovery times. The ketorolac group had lower postoperative pain scores and required less frequent analgesic therapy in the early postoperative period compared with the acetaminophen and placebo groups. In contrast, there were no differences in pain scores or analgesic requirements between the acetaminophen and the placebo groups. We conclude that the preoperative administration of oral ketorolac, but not acetaminophen, provided better postoperative pain control than placebo in children undergoing bilateral myringotomy.
术前预防性使用镇痛药可降低术中麻醉药需求量，并减轻术后早期的疼痛。在一项双盲、安慰剂对照研究中，我们纳入了90例健康的美国麻醉医师协会（ASA）身体状况为I或II级、接受双侧鼓膜切开术的儿童，比较了在麻醉诱导前30分钟给予口服对乙酰氨基酚和酮咯酸的术后镇痛效果。患者被随机分为接受生理盐水（0.1 ml·kg-1）、对乙酰氨基酚（10 mg·kg-1）或酮咯酸（1 mg·kg-1），均用樱桃糖浆稀释至总体积5 ml。通过面罩用氟烷和氧化亚氮诱导并维持麻醉。由一名不知情的观察者使用客观疼痛量表评估术后疼痛。三个研究组在人口统计学数据、麻醉和手术持续时间、诱导行为、血氧饱和度、术后呕吐发生率及恢复时间方面相似。与对乙酰氨基酚组和安慰剂组相比，酮咯酸组术后疼痛评分更低，且术后早期所需的镇痛治疗频率更低。相比之下，对乙酰氨基酚组和安慰剂组在疼痛评分或镇痛需求方面没有差异。我们得出结论，对于接受双侧鼓膜切开术的儿童，术前口服酮咯酸而非对乙酰氨基酚，比安慰剂能提供更好的术后疼痛控制。
