Pavlin Dorothy J, Pavlin Edward G, Horvath Karen D, Amundsen Laurie B, Flum David R, Roesen Kristine
Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA, USA.
Anesth Analg. 2005 Jul;101(1):83-9, table of contents. doi: 10.1213/01.ANE.0000155958.13748.03.
In this study, we compared pain scores after inguinal herniorrhaphy in patients treated by preincisional local anesthetic field block (PL), or PL combined with perioperative rofecoxib, with controls who received standard care. Seventy-five patients having herniorrhaphy under general anesthesia were randomly assigned to receive a placebo pill preoperatively, and for 5 days postoperatively (CONT); preoperative bupivacaine field block and perioperative placebo (PL); preoperative field block plus rofecoxib, 50 mg preoperatively and for 5 days postoperatively (PLR). Bupivacaine infiltration in the wound at closure, IV fentanyl and acetaminophen/oxycodone were administered postoperatively to all. Discharge time, pain scores (0-10), analgesic use, and satisfaction scores (1-6) were compared using analysis of variance. PLR patients had lower maximum pain scores (worst pain) in the postanesthesia care unit (3.7 versus 5.3, P = 0.02) and at 24 h (5.3 versus 6.8, P = 0.03), were discharged 38 min sooner (P = 0.01), required 28% less oxycodone 0-24 h after discharge (P = 0.04), and reported higher satisfaction scores compared with CONT. Pain in PL was less than CONT for 30 min. There were no differences among the 3 groups after 24 h postoperatively. We conclude that perioperative rofecoxib with PL reduces in-hospital recovery time, decreases pain scores and opioid use, and improves satisfaction scores in the first 24 h after surgery.
在本研究中，我们比较了接受切口前局部麻醉区域阻滞（PL）或PL联合围手术期罗非昔布治疗的腹股沟疝修补术后患者的疼痛评分，与接受标准护理的对照组。75例在全身麻醉下进行疝修补术的患者被随机分配，术前及术后5天接受安慰剂丸（CONT）；术前布比卡因区域阻滞及围手术期安慰剂（PL）；术前区域阻滞加罗非昔布，术前50 mg及术后5天（PLR）。所有患者术后均在伤口闭合时给予布比卡因浸润、静脉注射芬太尼及对乙酰氨基酚/羟考酮。采用方差分析比较出院时间、疼痛评分（0 - 10）、镇痛药物使用及满意度评分（1 - 6）。PLR组患者在麻醉后护理单元的最大疼痛评分（最严重疼痛）较低（3.7对5.3，P = 0.02），24小时时也较低（5.3对6.8，P = 0.03），出院时间早38分钟（P = 0.01），出院后0 - 24小时所需羟考酮减少28%（P = 0.04），且与CONT组相比满意度评分更高。PL组在术后30分钟时疼痛程度低于CONT组。术后24小时后三组之间无差异。我们得出结论，围手术期罗非昔布联合PL可缩短住院恢复时间，降低疼痛评分及阿片类药物使用量，并提高术后24小时内的满意度评分。
