Jung Young-Soo, Kim Moon-Key, Um Yoo Jung, Park Hyung-Sik, Lee Eui-Wung, Kang Jeong-Wan
Department of Oral and Maxillofacial Surgery, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Nov;100(5):559-63. doi: 10.1016/j.tripleo.2005.02.065.
Many studies on the efficacy of preemptive analgesia have been processed in different ways. But the value of preemptive analgesia is still controversial. The goal of this study was to compare analgesic effects of a nonsteroidal anti-inflammatory drug (NSAID) for oral surgical pain according to 3 different administration times.
Using a randomized, parallel-group, single-center, and active-controlled test design, this study was conducted with 80 healthy patients undergoing a surgical removal of an impacted mandibular third molar requiring bone removal. The oral NSAID was first administered 1 hour preoperatively, or 1 hour postoperatively, or no scheduled administration pre- or postsurgery. Whenever patients felt at least moderate pain (score > or =5 on a 10-point scale) after surgery, they were instructed to take the same drug. Pain intensities and times to the first and second onsets of postoperative pain from the end of surgery were assessed for 24 hours.
Of the 80 enrolled subjects in this study, 25 patients were assigned to the preemptive group, 26 to the posttreatment group, and 29 to the no-treatment group. The demographic distribution and duration of surgery in the 3 groups were statistically similar. The mean time to first onset of postoperative pain was significantly prolonged in the posttreatment group (277.2 minutes, P < .05) compared to the preemptive group (158.4 minutes) and the no-treatment group (196.5 minutes). The mean time to second onset of postoperative pain was not significantly different among the 3 groups. No significant statistical difference was found among the mean pain intensities at the first and second onsets of postoperative pain in the 3 groups.
In this small selected group of subjects and limited study design, the analgesic effects of NSAID administered preoperatively were no longer effective for postoperative pain. The results in this population imply that scheduled postoperative analgesics before pain development are adequate for postoperative analgesia without preoperative administration.
许多关于超前镇痛疗效的研究采用了不同的方式。但超前镇痛的价值仍存在争议。本研究的目的是根据3种不同给药时间比较一种非甾体抗炎药（NSAID）对口腔手术疼痛的镇痛效果。
采用随机、平行组、单中心、活性对照试验设计，对80例需要进行骨切除的健康患者进行下颌阻生第三磨牙拔除手术。口服NSAID分别在术前1小时、术后1小时给药，或手术前后不进行定时给药。术后患者一旦感到至少中度疼痛（10分制评分≥5分），即指导其服用相同药物。评估术后24小时的疼痛强度以及从手术结束到术后首次和第二次疼痛发作的时间。
本研究纳入的80名受试者中，25例患者被分配到超前镇痛组，26例到治疗后组，29例到未治疗组。3组的人口统计学分布和手术持续时间在统计学上相似。与超前镇痛组（158.4分钟）和未治疗组（196.5分钟）相比，治疗后组术后首次疼痛发作的平均时间显著延长（277.2分钟，P<.05）。3组术后第二次疼痛发作的平均时间无显著差异。3组术后首次和第二次疼痛发作时的平均疼痛强度之间未发现显著统计学差异。
在这个经过挑选的小样本受试者群体和有限的研究设计中，术前给予NSAID的镇痛效果对术后疼痛不再有效。该人群的结果表明，在疼痛出现前定时给予术后镇痛药足以实现术后镇痛，无需术前给药。
