Ong K S, Seymour R A, Chen F G, Ho V C L
Department of Oral and Maxillofacial Surgery, National University of Singapore, 238877 Singapore, Republic of Singapore.
Int J Oral Maxillofac Surg. 2004 Dec;33(8):771-6. doi: 10.1016/j.ijom.2004.01.020.
There is uncertainty regarding the role of preemptive analgesia in preventing postoperative pain. Most previous studies were of parallel design completed under general anesthesia with many confounding inter-patient's variables. The present study evaluated the efficacy of preemptive ketorolac in a crossover design in patients undergoing bilateral mandibular third molar surgery. This was a double blind, randomized, placebo-controlled study where 34 patients had each of their identical impacted mandibular third molars removed under local anesthesia on two occasions. Each patients acted as their own control; one side was pretreated with intravenous ketorolac 30 mg before surgery followed by placebo injection after surgery, and for the other side, the patient was given placebo injection before surgery and post-treated with intravenous ketorolac 30 mg after surgery. The difference in postoperative pain between pretreated and post-treated side in each patient was assessed by four primary end-points: pain intensity as measured by a 100-mm visual analogue scale hourly for 12 h, time to rescue analgesic, postoperative analgesic consumption, and patient's global assessment. Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac pretreated sides when compared with the post-treated sides (P = 0.003). Patients also reported a significantly longer time to rescue analgesic (8.9 h versus 6.9 h, P = 0.005), lesser postoperative analgesic consumption (P = 0.007) and better global assessment for the ketorolac pretreated sides (P = 0.01). Pretreatment with intravenous ketorolac has a preemptive effect for postoperative third molar surgery and extended the analgesia by approximately 2 h.
关于超前镇痛在预防术后疼痛中的作用存在不确定性。以往大多数研究采用平行设计，在全身麻醉下完成，存在许多患者间的混杂变量。本研究采用交叉设计评估了超前使用酮咯酸在双侧下颌第三磨牙手术患者中的疗效。这是一项双盲、随机、安慰剂对照研究，34例患者在局部麻醉下分两次拔除其两侧相同的下颌阻生第三磨牙。每位患者均作为自身对照；一侧在手术前静脉注射30mg酮咯酸进行预处理，术后注射安慰剂，另一侧患者在手术前注射安慰剂，术后静脉注射30mg酮咯酸进行后处理。通过四个主要终点评估每位患者预处理侧和后处理侧术后疼痛的差异：用100mm视觉模拟量表每小时测量一次疼痛强度，共测量12小时；使用解救镇痛药的时间；术后镇痛药的消耗量；以及患者的总体评估。在整个12小时的研究期间，与后处理侧相比，患者报告酮咯酸预处理侧的疼痛强度评分显著更低（P = 0.003）。患者还报告酮咯酸预处理侧使用解救镇痛药的时间显著更长（8.9小时对6.9小时，P = 0.005），术后镇痛药消耗量更少（P = 0.007），总体评估更好（P = 0.01）。静脉注射酮咯酸预处理对下颌第三磨牙术后有超前镇痛作用，并将镇痛时间延长了约2小时。
