Diblasio Christopher J, Snyder Mark E, Kattan Michael W, Russo Paul
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 2004 Mar;171(3):1062-5. doi: 10.1097/01.ju.0000109961.69936.8e.
Ketorolac has demonstrated advantages as a supplement to opioid based analgesia in several surgical settings, including donor nephrectomy. To our knowledge there has been no published data to date on the use of ketorolac in patients undergoing partial nephrectomy. We compared analgesia with ketorolac and opioids to analgesia with opioids alone with regard to pain control, postoperative recovery and effects on renal function in patients with renal cortical tumors surgically managed by partial nephrectomy.
Records for 154 patients treated with partial nephrectomy for renal cortical tumors were retrospectively analyzed. Clinicopathological variables examined were age, gender, medication use, comorbidity profile, operation side, estimated blood loss, hospital stay, operative duration, American Society of Anesthesiologists class, histopathology results, perioperative transfusion status, ischemia type (warm vs cold vs none), duration of renal artery cross clamping, tumor size and intraparenchymal location, pathological stage and perioperative complications. Postoperative duration to the initiation of solid diet, discontinuation of patient controlled analgesia and overall pain control were assessed. Serum creatinine was measured during the preoperative period, and at 1, 3 or greater and 30 or greater days postoperatively.
Patients who received ketorolac demonstrated superior postoperative recovery with an earlier return to solid diet and earlier discontinuation of patient controlled analgesia. Treatment groups were similar with respect to changes in serum creatinine, blood loss, transfusion rates and complication rates. Ketorolac was not associated with an increased risk of acute renal failure.
Ketorolac is a safe and effective supplement to opioid based analgesia for pain control after partial nephrectomy.
酮咯酸已在包括供体肾切除术在内的多种手术环境中显示出作为阿片类药物镇痛补充剂的优势。据我们所知，迄今为止尚无关于酮咯酸在接受部分肾切除术患者中使用的已发表数据。我们比较了酮咯酸与阿片类药物联合镇痛与单纯阿片类药物镇痛在接受部分肾切除术治疗肾皮质肿瘤患者的疼痛控制、术后恢复及对肾功能影响方面的差异。
回顾性分析154例因肾皮质肿瘤接受部分肾切除术患者的记录。检查的临床病理变量包括年龄、性别、用药情况、合并症情况、手术侧、估计失血量、住院时间、手术时长、美国麻醉医师协会分级、组织病理学结果、围手术期输血情况、缺血类型（温缺血vs冷缺血vs无缺血）、肾动脉夹闭时间、肿瘤大小及实质内位置、病理分期和围手术期并发症。评估术后开始进食固体食物的时间、停止患者自控镇痛的时间及总体疼痛控制情况。术前及术后1天、3天或更晚、30天或更晚时测定血清肌酐。
接受酮咯酸治疗的患者术后恢复更佳，更早恢复进食固体食物且更早停止患者自控镇痛。治疗组在血清肌酐变化、失血量、输血率和并发症发生率方面相似。酮咯酸与急性肾衰竭风险增加无关。
酮咯酸是部分肾切除术后基于阿片类药物镇痛进行疼痛控制的安全有效补充剂。
