Kumar Anup, Deed Jagpreet S, Bhasin Bharat, Kumar Ashok, Thomas Shaji
Department of Surgery, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India.
ANZ J Surg. 2004 Jul;74(7):573-6. doi: 10.1111/j.1445-2197.2004.03058.x.
Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been used to relieve biliary colic, the role of these drugs in the natural history of biliary colic has not been clarified. The objective of the present study is to compare the efficacy of intramuscular diclofenac with intramuscular hyoscine in the treatment of pain of acute biliary colic, and to study their role in the natural history of biliary colic and in the prevention of cholelithiasis-related complications.
Seventy-two consecutive patients with biliary colic were enrolled in this prospective, randomized, double-blind study. They received either a single 75 mg intramuscular dose of diclofenac (n = 36) or similarly administered 20 mg of hyoscine (n = 36). Pain severity was recorded on a visual analogue scale 30 min, 1 h, 2 h and 4 h after injection of the drug. Patients were then followed closely for the next 72 h for persistence or relapse of pain, or development of acute cholecystitis, or drug related complications.
Diclofenac provided much more rapid relief of pain than hyoscine, as shown by significantly lesser pain scores after injection of the drug. 91.7% of patients on diclofenac were completely relieved of pain at 4 h as compared to 69.4% with hyoscine (P = 0.037). Progression to acute cholecystitis was seen in only 16.66% of patients on diclofenac as compared to 52.77% on hyoscine (P = 0.003).
In patients with biliary colic, diclofenac gives much faster and more effective pain relief in a significantly larger number of patients as compared with hyoscine. Most remarkably, diclofenac can prevent progression of biliary colic to acute cholecystitis in a significant number of patients.
尽管非甾体抗炎药（NSAID）和解痉药已被用于缓解胆绞痛，但这些药物在胆绞痛自然病程中的作用尚未明确。本研究的目的是比较肌内注射双氯芬酸与肌内注射东莨菪碱治疗急性胆绞痛疼痛的疗效，并研究它们在胆绞痛自然病程及预防胆石症相关并发症中的作用。
72例连续的胆绞痛患者纳入了这项前瞻性、随机、双盲研究。他们接受单次肌内注射75mg双氯芬酸（n = 36）或同样方式给予的20mg东莨菪碱（n = 36）。在注射药物后30分钟、1小时、2小时和4小时，采用视觉模拟量表记录疼痛严重程度。然后在接下来的72小时密切随访患者，观察疼痛持续或复发情况、是否发生急性胆囊炎或药物相关并发症。
双氯芬酸比东莨菪碱能更快缓解疼痛，注射药物后疼痛评分显著更低表明了这一点。注射双氯芬酸的患者中91.7%在4小时时疼痛完全缓解，而注射东莨菪碱的患者为69.4%（P = 0.037）。双氯芬酸组仅有16.66%的患者进展为急性胆囊炎，而东莨菪碱组为52.77%（P = 0.003）。
对于胆绞痛患者，与东莨菪碱相比，双氯芬酸能在显著更多的患者中更快、更有效地缓解疼痛。最显著的是，双氯芬酸能在相当数量的患者中预防胆绞痛进展为急性胆囊炎。
